Nurses and other members of the healthcare community have both the power and responsibility to reduce disparities in access to telehealth services, Mark Rastetter, MD, Cynthia J. Sieck, PhD, MPH, and Rose Grady, FNP, said during a session held at the ONS BridgeTM virtual conference on September 14, 2021. They shared their experience creating digital equity among patients using telehealth at Ohio State University’s (OSU’s) Wexner Medical Center.

When the COVID-19 coronavirus pandemic shut down the United States in March 2020, access to telehealth services went from a want to a need. During that time, use of telehealth expanded significantly, with more than 30% of all Medicare visits conducted via telehealth during the first half of 2020, and it grew even further when the Centers for Medicare and Medicaid Services issued its emergency waivers that enhanced telehealth coverage and reimbursement, the speakers said.

But not all patients have equal access. Higher poverty is associated with less telehealth use, with barriers including the cost of broadband internet and digital devices (e.g., phones, tablets, personal computers). In addition, telehealth requires digital literacy skills to use those devices.

Telehealth is a broad term that includes telemedicine and virtual care, Rastetter et al. explained during the session. Telemedicine may include video chat, audio only (i.e., phone calls), instant messaging, or email-based treatment. Virtual care encompasses telemedicine but also incorporates remote monitoring platforms with pre and post visit follow-ups and digital tools that communicate in real time.

To use telehealth, patients need three key factors: devices, connectivity, and digital literacy. OSU uses a digital health readiness assessment, which is based on the Engagement Capacity Framework, to determine their patients’ capacity to use telehealth. 

The presenters examined access to telehealth through the 5 A’s of Health Care Access, which outlines the critical components of providing care across social and cultural segments: affordability, availability, accessibility, accommodation, and acceptability.

To understand how communities are tackling the digital divide, the presenters used a program called Partners Achieving Community Transformation (PACT), a nonprofit affiliate of OSU Wexner Medical Center. In March 2020, PACT launched the Connected Communities Fund to address the widening digital divide made apparent through the pandemic. Its tagline is, “The internet is not a luxury in 2020. It’s a utility required for life.” Through the Big Give and the Columbus Foundation, PACT began fundraising to eliminate the digital divide, and it was awarded $200,000 of CARES Act funding to distribute devices on Columbus’s Near East Side.

PACT focuses on creating digital equity by providing those three key telehealth factors for patients: affordable and effective broadband, devices, and digital literacy. The program’s initial survey and feasibility assessment revealed that 39% of residents did not have a reliable fixed internet and nearly 12% had no internet access at all. Cost was one of the primary barriers, and more than 60% were not aware of broadband discount and subsidy programs. The price point that would prompt residents to adopt internet was about $25 per month.

"As health care continues to expand into the digital and virtual worlds, which we see as generally a positive shift for patients, it is important to recognize that there is a divide being created between those who have the resources to access these services and those who do not,” Rastetter said. “This digital divide will widen health care disparities if proper steps are not taken to mitigate the challenges of creating equitable access for all patients.”