Using Telehealth to Support Equitable Access to Care

General Strategies: Telehealth in Areas without Reliable Internet Access

• Use textable video links that can be sent to families/caregivers outside of the patient portal.
• Use an electronic health record embedded video visit platform that does not require the download of an app.
• Assign a member of the practice staff who will serve as the point of contact for families/caregivers to help with trouble shooting technical issues.
• Proactively identify patients at risk for technical challenges with video visits.
  • Develop a workflow that proactively prepares to offer alternative options to these families/caregivers such as audio-only visit services.
• Develop a work group within the practice to improve integration of interpreter services into video visits.
• Prepare and send instructions to families/caregivers on how to join the telehealth visit in advance of the visit.
  • Send families text messages and/or links to a web site which provides video and text instructions of how to join telehealth visits.

Preliminary outcomes associated with these tips and strategies include high patient/family satisfaction and increased access to care for families/caregivers.

^{The tips and strategies outlined on this web page were provided by Johns Hopkins University School of Medicine.}

Hot Spots, Loaner Device Programs and Community Kiosks

One practice implemented loaner device programs and community kiosks to offer technology access for patients and families/caregivers. Strategies to support this practice included the following.

• Establish a community outreach team to support navigation of community resources.
• Build partnerships with the local mobile carrier to negotiate purchase of SIM cards and hot spots to loan for families/caregivers who may not have reliable internet access at home.
• Leverage additional community partnerships, such as with public school systems, to offer technology and internet resources.
• Secure local grants to purchase mobile tablets and create a Loaner Device Program for patients and families/caregivers. This program includes the following components:
  • Multi-lingual patient education materials to demonstrate to families/caregivers how to use the device and connect to a telehealth visit.
  • Legal agreement illustrating recognition of loan.
  • Eligibility criteria.
  • Management and storage of devices.
  • Configuration of device for security.
  • Pathway for mailing or dispensing the device to families/caregivers.
  • System for tracking and logging the devices loaned.
• Set up community “kiosks” where patients can access telehealth visits in their own communities. This program includes the following components:
  • Complete a mapping process to understand where to place the kiosks by developing an understanding of social vulnerabilities and densely populated patient care areas.
  • See above, same configuration considerations as for the Loaner Device Program.
  • Rolling cart and tablet locking capabilities.
  • Agreements for location of use.
  • Education for self-service and staff support use.
• Interview families/caregivers to understand which option (Loaner Device Program or Community Kiosk) would be of most value in certain communities.
• Develop “how to connect” videos translated into multiple languages.
  • Post these videos on your practice or hospital web page.
  • Assign volunteers to call first time telehealth visit users and help navigate their set up and expectations for the visit.

^{The tips and strategies outlined on this promising practice were provided by Anonymous Contributors.}

Telehealth for Native American Communities in Rural Areas

One practice supports access to telehealth for Native American populations in rural areas by building partnerships between pediatric practices and school-based health clinics. Strategies to support this practice included the following.

• Organize and provide a telemedicine cart for use within school-based health clinics.
• Provide training to nursing staff at the school-based health clinic to set up telehealth visits through the telemedicine cart.
• Nurses and other school-based health clinic staff gather vital signs and other physical examination findings for children physically present within the school-based health clinic.
• School-based health clinic staff support a telehealth visit using the telemedicine cart at the clinic between a pediatrician and/or specialist and the child.
• Nursing staff at the school-based health clinic follow up on medications and any other referrals after the telehealth visit.
• School-based health center clinical staff gather vital signs and then connect the child/patient with the pediatrician and or specialist using telehealth through the telemedicine cart.

Preliminary outcomes include improved access to care and access to pediatric subspecialty services.

^{The tips and strategies outlined on this promising practice were provided by Health Promotion Disease Prevention Fort Peck Tribes, Montana and Montana Pediatrics, Bozeman Health Pediatrics.}