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.
Broadband and Device Access. There are multiple avenues to support patients’ ability to access and use telemedicine services such as video visits. Multiple existing programs exist to help patients sign up for low-cost devices, data plans, and broadband.
- National Digital Inclusion Alliance: COVID-19 Resources — This webpage has a list of COVID-19 resources, including low-cost broadband programs.
- Federal Communications Commission (FCC): Lifeline Program for Low-Income Consumers — This webpage has an overview of the FCC’s Lifeline Program, which supports smartphone ownership for low-income Americans.
Digital Skills Training. In addition, many groups can provide support for patients who need basic training to use a smartphone or computer, such as learning to download apps or conduct online searches. While resources vary within regions and cities, the public library system is often an important place to start for basic skills training, both nationally as well as through your local public library branches to determine offerings.
- Public Library Association: Digital Learn Program — This webpage has a collection of online tutorials covering computer and internet basics.
- TeleHealth Access for Seniors — This webpage has multiple guides for digital literacy basics, including translation of guides into multiple languages.
Technical Support for Patients. Finally, health care systems themselves can bolster the technical support they provide for patients. Specific questions about the platforms used within your setting are likely best handled by your organization, such as how to use the patient portal to get into a video visit or how-tos on using a specific video vendor platform.
- Alameda Health System: Digital Health Outreach Playbook — This playbook contains a wealth of resources for supporting patients in accessing digital health tools, including the patient portal, that are often necessary for telemedicine. Starting on page 10 it includes a phone script for screening patients’ digital access and helping them enroll in the MyChart patient portal, and starting on page 12 it includes a pictorial-based tip sheet to help patients download a patient portal app. The additional resources starting on page 27 also include email templates and instructions to help patients sign up for and download MyChart in both English and Spanish. This playbook was created by the Alameda Health System — an integrated public health care system of 5 hospitals and 4 wellness centers promoting wellness, eliminating disparities, and optimizing the health of diverse communities in Alameda County, California regardless of social and financial barriers — as part of their work through CCI’s Connected Care Accelerator.
- UCSF Center for Vulnerable Populations: Resources for Telehealth at Safety Net Settings — The “For Patients” section of this webpage includes a PDF with Zoom visit instructions, as well as brief video tutorials for patients to download this app in English, Cantonese, Mandarin, Russian, Spanish, and Vietnamese on both Android phones and iPhones. Also, the section on “Considerations for using Remote Visits within Safety Net Healthcare Settings” has workflow considerations for providing care by telemedicine to patients with limited digital literacy.
- Journal of the American Medical Informatics Association: Portal Implementation Activities at Five Community Health Centers in California — This table, from a rapid ethnography of patient portal implementation at safety-net health centers in California shows a range of community health center activities to promote portal use among diverse patients.