Central to effective and equitable implementation of telemedicine care is engaging a diverse patient population. This is one of the most pressing areas of consideration to ensure telemedicine does not worsen existing health disparities.
While smartphone ownership in the US continues to climb, the digital divide in the US persists for many. Groups with the lowest rates of home Internet use and smartphone ownership include low-income Americans, older adults, and those living in rural areas. In addition, more than a quarter of low-income individuals use their smartphone as their only online access point, without home internet, presenting challenges for sufficient data/bandwidth to connect to video visits. Finally, barriers related to digital literacy — the skills to be able to use email, apps, and other online tools — are common for many patients even if they have access to a device. Health care systems can screen patients’ digital access and skills, allowing for improved alignment between workflows and patient needs. Screening could also include patient preferences for communication (in-person, phone, text, email, etc.), to ensure support for digital modalities while simultaneously supporting patient preferences for their care.
- San Francisco Digital Equity Initiative: SF Digital Equity Playbook — This PDF includes concrete guidance on assessing digital access and skills. This playbook includes sample intake forms which could be used to screen patients’ digital needs on page 16.
- UCSF Center for Vulnerable Populations: Sample Questions to Screen Patient Digital Needs — This PDF includes questions health care systems can adapt and use to assess patients’ digital needs, including internet use, device access, broadband and data plan access, and confidence using technology.