Telehealth in the COVID-19 Era: Illuminating the Digital Divide in Patient Access

Leaders of healthcare systems have long understood the benefits of telehealth, and the COVID-19 pandemic has shown that healthcare systems have the capacity to rapidly adopt digital solutions. In just six months, we have seen a decade’s worth of digital transformation. For example, 46% of U.S. consumers are now using telehealth compared with just 11% in 2019. But will the benefits of telehealth be experienced by those who could benefit most?

With face-to-face interactions restricted, telehealth has allowed health systems worldwide to provide patients with access to ongoing care. Digital solutions such as remote patient monitoring (through devices or patient-reported outcomes) and video clinic visits have helped bring healthcare providers and patients both back in touch, and simultaneously, into unchartered waters.

The rapid reshaping of the way care is delivered and received has increased our reliance on the internet to access healthcare. In an ideal world, telehealth and other forms of technology-enabled care would improve access to healthcare in areas where access is limited. However, limited access to the internet has resulted in a healthcare “digital divide” – defined as the gap that exists between individuals who have access to modern information and communication technology and those who lack access.3

Recognizing the Digital Divide in Healthcare 

Those fortunate enough to have unlimited access to telehealth platforms may be surprised to find that 41% of the world’s population doesn’t have internet access.2 There are many reasons for this digital divide, including personal, socioeconomic and structural barriers, such as limited digital literacy and geographic isolation. With the continued threat of COVID-19, these barriers can mean the difference between life and death.

Unfortunately, these health inequalities are likely to worsen as we begin to rely more on digital services in healthcare. As health systems continue to be digitized, it’s important to understand barriers to patient access so we can address them:

  • Age: There is a wide disparity in internet use between people age 18 to 29 and those age 65 and older. Fewer older people engage with smartphones and computers regardless of whether the technology is easily accessible to them. Research has shown that generations that didn’t grow up with limitless technology solutions need more training to gain a good understanding of new technologies, especially those regarding healthcare.4
  • Socio-economic background: While 87% of people in developed countries use the internet, only 19% of those in developing countries do so.5Having a lower income and being of minority race or ethnic background not only impedes people’s access to health services but presents an added barrier to accessing telehealth. Recent research has shown that the proportion of non-Hispanic white patients accessing health services was approximately 40% higher than for Black/African and Latinx patients since the COVID-19 outbreak began.6 This represents a potentially life-threatening reality in a time of digital transformation.
  • Geographic location: In the United States, one in four rural Americans does not have internet access at home, primarily due to fewer telephone lines and internet cables in those areas.7 Reduced connectivity to telehealth services could lead to health complications for rural populations.

Bridging the Gap  

Addressing these barriers and minimising health inequality and ensuring digital health is inclusive is possible with the following:

  • Telephone consultations – including call-back or freephone telephone services that provide an alternative to online video consultations
  • Telehealth kiosks – providing accessible care in areas of limited broadband access. Such units can be installed at pharmacies, supermarkets and recreation centres.
  • Telehealth literacy training – promoting the use of publicly available services (e.g., community centres and libraries) to provide resources and training to communities with low digital literacy
  • Accommodating language barriers – providing translating capabilities for telehealth websites and applications in a variety of languages
  • Internet as a basic need – governments can work toward prioritising improved broadband access for the most disadvantaged populations

As the COVID-19 pandemic continues worldwide, it will be important to identify even more ways to increase access to telehealth and ensure that people with limited access to the internet aren’t left behind.

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  1. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? 2020.
  2. Digital users worldwide 2020 .
  3. Steele C. What is the Digital Divide? | Digital Divide Council. 2020.
  4. Vaportzis E, Clausen MG, Gow AJ. Older adults perceptions of technology and barriers to interacting with tablet computers: a focus group study. Front Psychol. 2017;8:1687.
  5. Staines R. Digital divide threatens health and wellbeing during pandemic – UN -. 2020.
  6. Insights on racial and ethnic health inequity in the context of COVID-19, 2020.

Covid-19 exposes digital divide in healthcare. Direct Relief. 2020.

Efua Obetoh
Efua Obetoh

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