The COVID-19 pandemic unlocked new avenues to extend care beyond brick-and-mortar facilities. 

But as health systems have turned to telemedicine to bridge the gap between in-person services and at-home needs, stakeholders stress the importance of optimizing access for a broad range of patients.

"While telehealth has evolved and scaled significantly during the pandemic, continued work is needed to ensure health equity and to bridge digital divides for future paradigms of care," observed Dr. Saima Aftab, vice president of organizational initiatives at Nicklaus Children's Health System in Miami.

"Promoting access to care and health equity using telehealth has great potential to mitigate healthcare disparities for patients living in underserved communities," Aftab continued.

At Nicklaus, where the telehealth program has been operational since 2013, the team has worked to address individualized patient concerns through a variety of tactics.

"Supporting families with connectivity needs in their home environment was very important to our success," said Evelyn Terrell, director of telehealth and special projects at NCHS.

Strategies included operationalizing a call center to provide timely support; surveying patients and families on their virtual care experience; reviewing feedback; and taking action on any improvements, explained Terrell and Aftab, who will offer a closer look at the program during their HIMSS22 panel in Orlando this March.

"The continuous … improvement process, program evaluation and regular review of key performance indicators [are] key to measuring opportunities for improvement to optimize access for culturally diverse communities," said Terrell.

The majority of virtual care services at NCHS have been delivered through its proprietary, encrypted HIPAA-compliant telehealth app – which came in handy when COVID-19 began slamming the United States.

"During the pandemic, we ensured convenient access to care for our patients and families in a wide range of services, and have worked to create innovative hybrid models of virtual care," said Terrell.  

She noted that in 2020, the system expanded programs and services to more than 24 specialties, demonstrating a greater than 9,000% increase in virtual visits compared to the prior year. Even as nationwide utilization of telemedicine decreased, Terrell says volumes were sustained in 2021.

"Telehealth has shown to be an effective strategic imperative to enhance access to care and improve other key performance indicators, such as wait time for an appointment and patient satisfaction," she said. 

She drew particular attention to the role virtual care can play in behavioral health, which allows the organization to safely serve more children than in the traditional office-based model.

"In 2021, tele-behavioral health accounted for 51% of virtual care encounters, which followed another busy year in 2020, when 42% involved behavioral health," she said.

The rapid scaling of telehealth services did pose hurdles, namely around connectivity and accessibility, said the NCHS team.

"The expedited enrollment of patients and providers presented some technology and staffing challenges," said Terrell. "Barriers to access were identified for specific patients due to technological challenges, language barriers, digital literacy and other factors. 

"The dependency on strong WiFi for certain services, such as [those for] home and school-based patients, was another challenge," she said.

But NCHS sought to foster strong consumer and provider engagement, she said, in order to try and mitigate some of those roadblocks.

"A driver of successful expansion of virtual care services is open communication and collaboration with key stakeholders, including listening to the 'voice of the customer,' on important initiatives that impact the virtual care process," she said.

Selecting the right information and technology tools is also vital, she added. 

"A best practice is to develop a roadmap for virtual care platform enhancements, optimization and other technological advances, such as improved workflows, new capabilities, such as integration with the EHR, and other functionalities to improve the patient experience," she said. 

"Training and education of all users is key to ensuring the delivery of quality virtual care services and tools should be frequently reviewed and modulated based on feedback," she continued.

The team highlighted telemedicine's potential to reduce disparities in healthcare outcomes.

"Telehealth provides opportunities to create efficiencies," said Aftab. 

It can "optimize staffing resources, enhance access to care and reduce travel related costs for patients and families," she noted. At the same time, it's necessary to consider contextual factors too.

"Studies have investigated how socioeconomic and sociodemographic factors may negatively affect digital health utilization," said Aftab. "Inequitable adoption of virtual-digital health platforms and telehealth utilization may be influenced by digital literacy, educational or language barriers, and other social determinants.

"Some studies have shown a correlation between digital literacy and telehealth usability or reliability in digital health adoption and utilization with social determinants of health.

Aftab described how telehealth can enable more seamless chronic health management through remote technology, thereby improving patient quality outcomes.

"This is especially true for patients who live in rural areas who wouldn’t otherwise be able to access quality specialists without significant travel to distant health facilities," said Aftab. 

That said, access to virtual health is not just an issue in rural areas. 

"Patients in our primary urbanized service area, especially those in low socioeconomic status areas and culturally diverse communities, demonstrate many healthcare disparities," Aftab added. "Patients may experience linguistic isolation, poverty and cost constraints, which can impede families from traveling even short distances to seek care.

"A key consideration an organization can follow to mitigate barriers is to strive toward a culture of innovation and transformation, and establish strong community partnerships," she said.

Aftab and Terrell will discuss more in their panel, "Digital Connectivity as a Social Determinant of Health." It's scheduled for Wednesday, March 16, from 11:30 a.m.-12:30 p.m. in Orange County Convention Center WF4.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.