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Health Righters Collaboration

Telemedicine for the Underserved Communities: How Can Doctors Do Better?

by Hiranya Atreya (University of Cincinnati, ’23)

From the onset of the COVID-19 pandemic, the recent surge in telehealth claims to private insurers — a near 4347% increase — is ensuring that telehealth is slowly becoming more and more mainstream. Telemedicine has the potential to bridge the gap between socioeconomic divide and create more culturally sensitive attitudes towards healthcare for minorities and rural populations.

In terms of rural America, this means that nearly 22% of total Medicare beneficiaries in rural areas used telehealth services. The CARES Act allows “qualified health centers and rural health centers to serve as eligible sites of care for telehealth services” while also removing the geographic restrictions on Medicare coverage of telehealth services; this enabled most patients to access quality healthcare from any corner. However, this does not completely detract from the issue that about 12% of rural Americans are less likely to have internet connectivity. This is likely to decrease with the launch of the Rural Digital Opportunity Fund Auction, which will provide internet companies with $20 billion to expand their broadband networks and support rural areas. 

The applications of telehealth can extend beyond rural America. In India, there is a lack of awareness about the concept of primary health care, much less about the benefits of telehealth. With a population of nearly 1.353 billion people in India, there has been a lack of health education and poor accessibility to adequate healthcare. Many individuals in India live in dire poverty. But the advent of technology has ensured that many people, even the ones from slums, have some form of access to technology. The ISRO (Indian Space Research Organization) collaborated with the leading hospital group, Apollo, to begin the advent of telemedicine in India as early as 2001. Till today, 1 doctor serves approximately 1139 patients which is much higher than the maximum capacity suggested by WHO (about 1 doctor to 1000 patients). As telemedicine continues to bridge the gap between the urban and the rural, there is a chance of compensation for the decrease in doctors through the correct use of telehealth technologies to monitor patient health.

The best model of telemedicine might involve a degree of in-person interaction, face-to-face video conferencing, audio conversations, texting/emailing for quick updates, or check-ins on the patient. The prolonged connectivity through the varying mediums might allow for an increase in rapport with both doctor and patient, but it does eliminate the consistency present with only one primary mode of communication. Additionally, this  model of telehealth does assume that the patient has access to a good network and so on. It is often common practice for patients to check in with other Registered Medical Practitioners (RMPs) to get a second opinion, especially in countries like India wherein healthcare is not a model of trust due to ongoing corruption, medical negligence, and malpractice.

Telemedicine can also prevent the loss of patient-doctor connectivity and create personalized care for marginalized communities, including racial and ethnic minorities such as African-Americans, Latinx, and Native Americans. These communities often suffer from a lack of adequate healthcare access due to existing systemic racism inherent within the unstable medical healthcare system. Yet, with new Medicare and Medicaid laws in place, it will not be long before telehealth will overpower in-person visit preferences of minorities, as there is a much higher chance of equal care given to different persons, since there is not much in-person interaction. For example, the IHS (Indian Health Service) collectively works with several American Indian tribes to provide telehealthcare  catered to Native Americans. The Alaska Federal Health Care Access Network (AFHCAN) uses a store-and-forward platform to conduct examinations ranging from cardiology to ENT services (ear, nose, and throat) with more than 70% of all consultations conducted online, resulting in an estimated $8 to $10-million savings annually in the patient travel costs. The success of AFHCAN lies in that it uses the video teleconference as part of the store-and-forward program that is reimbursed by Medicaid.

Some ways to increase quality care and reduce health disparities amongst patients of all socioeconomic and racial status is to ensure that the patients have access to the required telemedicine equipment, such as iPads or laptops, by dropping them at the patient’s doorstop. As smartphones become the norm in most households, there is a larger need for utilizing user-friendly interfaces such as Zoom, Webex, Facetime, etc. in order to allow for easier patient transition into telehealth. The best way to make a patient with a language barrier feel welcome is to include an interpreter to be present in the call. As the need arises, there are BlueTooth powered devices that act as digital stethoscopes and blood pressure monitors. Simple and legible self-help manuals in various languages should be promoted online to acquaint the patient with telemedicine. As at-home health devices become common, it cannot be forgotten that many individuals will choose to not pay for the health devices due to varying socioeconomic factors. To ensure that the doctor can still have access to the patient’s vitals of weight, blood saturation levels, and blood pressure, it might be necessary for clinics and hospitals to dispatch individual nurses or health care workers to facilitate the telemedicine calls, especially for the elderly who might require assistance or at the least ensure pulse oximeters and other necessary equipment are lent to the patient in advance. 

Minor yet important considerations for doctors undertaking telemedicine consist of involving the patient and interacting with them by looking them in the eye while talking, a behavior many African-Americans assess to ensure that the doctors were being truthful. Some other interpersonal skills that doctors performing through telemedicine need to consider include having conversations with patients beforehand and assuring them of their qualifications and knowledge. Many Latinx and African-Americans were unsure about telehealth due to the underlying suspicion that the physician might not be what they claim to be — a thought process that stems from decades of health disparities amongst underserved communities. 

One of the pitfalls telemedicine has is that, in the coming years, it might become so mainstream that most doctor-patient relationships will rely only on technology. This could lead to potential data breaches and cybersecurity issues in relation to the HIPAA rules in place, as the internet is frequently a vulnerable place. Some other issues might include  the overuse of telemedicine, which could lead to the lack of clear judgment on the patient and the doctor regarding emergency situations that could have been prevented had the patient actually come into the clinic. There is certainly a thin line of balance that has to be walked by both doctor and patient to reduce the errors that might result from a telemedicine experience. Many physicians who have already transitioned into telemedicine suggest that the stability of telemedicine lies in having a clear parity payment plan in place for small clinics and private practices to survive.

Telehealth is a game-changer for the health industry. Yet, it still requires the nuanced understanding of culturally responsive care from physicians, regardless of whether the patient-doctor interaction is face-to-face or via telemedicine virtual calls. It becomes all the more necessary to initiate changes to the fragmented healthcare delivery system in ensuring that this golden opportunity does not get lost in translation for minorities and underserved communities. 

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