With the rapid expansion of telemedicine in light of the COVID-19 pandemic, ensuring that remote care reaches diverse, low-income patients and promotes health equity, rather than exacerbating health disparities, is critical. Through a partnership between the Center for Care Innovations, UCSF’s Center for Vulnerable Populations (CVP), and the Commonwealth Fund, we have developed this toolkit to provide background information as well as concrete guidance relevant to safety-net healthcare systems looking to initiate, expand, or improve their telemedicine programs.
This toolkit focuses on telemedicine, which the Health Resources Services Administration defines as referring to remote clinical services such as phone and video visits, remote patient monitoring, patient portals, and mobile health.
Over the coming year, as regulations and best practices in telemedicine continue to evolve, we will refresh and refine this toolkit. Specifically, we will integrate learnings from CCI’s Connected Care Accelerator and conduct interviews and surveys with healthcare providers and administrators to ensure this toolkit reflects the latest resources to meet on-the-ground needs. Further, as more resources become available focused on improving health equity through telemedicine for specific patient populations (e.g. patients of color, patients with limited English proficiency, gender-diverse patients, patients with limited digital literacy, older adult patients, and more), we will highlight them in this toolkit.
If you find that we have missed a key resource on telemedicine implementation in safety-net healthcare settings, please let us know by sending an email to [email protected]
Considerations for Leadership Before Implementing Telemedicine
The COVID-19 pandemic prompted health care providers and systems to rapidly adopt and expand telemedicine services. Telemedicine provides a safer alternative to in-person visits during the pandemic, but simultaneously introduces multiple decision points for implementation.
While many providers already have telemedicine in place, emerging evidence, policies, and guidance on implementation and maintenance indicate that answers to the question, “how do we implement telehealth equitably, safely, and sustainably?” are very much still evolving. In this chapter, we summarize many of the basic components of telemedicine implementation for health care system leaders, including:
- Evidence for implementing telemedicine,
- Risks, privacy and security,
- Vendor selection, and
- Performance measurement.
Considerations for Providers and Teams in Using Telemedicine
Once the decision to integrate telemedicine into routine care delivery is made, frontline care teams must begin to deliver telemedicine efficiently, safely, and equitably.
The key considerations for frontline teams include:
- Provider and team devices,
- Developing telemedicine visit workflows,
- Ensuring care visit quality and safety, and
- Supporting staff and team well-being.
Considerations for Reaching and Engaging Diverse Patients
Central to effective and equitable implementation of telemedicine care is engaging a diverse patient population.
Some of the most pressing areas of consideration to ensure telemedicine does not worsen existing health disparities include:
- Understanding patients’ digital access and skills,
- Connecting patients with technical support,
- Integrating interpreters into remote/virtual visits for those with limited English proficiency,
- Engaging patients’ caregivers and additional support services and teams, and
- Building a foundation of trust between patients and providers.
As we continue to scale telemedicine approaches in the COVID-19 pandemic and beyond, there will be many advanced features that can be implemented and optimized for safety net settings. We expect to refresh and expand this section of our toolkit in the coming months with real-world case studies and examples from CCI’s Connected Care Accelerator, which launched in mid-2020.