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During COVID-19, telemedicine became the go-to alternative to in-person visits. The technology holds great promise, especially for people who live in underserved communities. The technology helps to remove barriers that prevent people from getting the quality healthcare they deserve and gives them options that save time and money. For example, seeing a doctor remotely via smartphone could save a parent the loss of a day’s pay to take their sick child on the bus to an appointment in a distant neighborhood.
While telemedicine has the potential to make healthcare more equal regardless of where people live, work, play, and age, it has a long way to go as an equity tool. “While most of the parents I serve have smartphones, they can’t afford computers or internet access even with low-income allowances,” says Dr. Kelsey Schweiberger, pediatrician and Assistant Professor of Pediatrics at Pitt’s School of Medicine.
DR. KELSEY SCHWEIBERGER
Without dedicated internet access, parents must rely on local libraries or other public places with free wi-fi. “Internet access, unfortunately, has become another social determinant of health,” Dr. Schweiberger adds.
In addition to practicing and teaching medicine, Dr. Schweiberger studies how patients use telemedicine and patient portals (the application that allows patients to access their medical records), including what works and what doesn’t. She and her fellow researchers hope to improve health outcomes for everyone by making the technology convenient and simple.
Telemedicine meets patients where they live
One of the biggest advantages of telemedicine and patient portals is accessibility and flexibility. With a smartphone and public wi-fi, Dr. Schweiberger’s patients can schedule and visit her without leaving their neighborhood. “The technology gives people options they didn’t have before and that’s empowering. You’re able to care for yourself and your family consistently with less interruption to your work and routine,” she notes.
Patient empowerment includes the ability to ask questions and seek guidance from a provider through patient portal messages, which have increased HYPERLINK “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689796/”nationwideHYPERLINK “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689796/” more than HYPERLINK “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689796/”150HYPERLINK “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689796/”% since the pandemic. “As a pediatrician, I’m being asked questions about refills and follow-up physical and mental health care, especially when parents are worried,” she states. “The patient portal has the potential to make patients feel more informed and connected with their providers.”
Telehealth obstacles
Dr. Schweiberger is quick to add there are still obstacles that prevent people from using telemedicine. There are not systems in place that allow for affordable access to devices and internet for all. While some policies aim to improve access, it remains unaffordable for those who need it most. “While affordable wi-fi remains a barrier, there’s also a lack of digital literacy, which are the skills people need to use technology. Not everyone knows how — or wants to use — health apps and portals,” she explains.
There are also language issues, as some patient portals are currently only available in English. If telehealth technology is truly inclusive, it needs to have language options for non-native English speakers. “My practice includes families who speak a total of 30 languages in their homes,” Dr. Schweiberger says. “Pittsburgh is beautifully diverse and we are working to reflect that in our telehealth technology.”
Dr. Schweiberger has found that not being able to speak or understand English well hasn’t stopped her resilient and resourceful patients from using the portal. “They navigate using icons. For example, they understand to click on the letter icon to send a message to their doctor. Despite our current English-only portal, they’re connecting with us, which we hope to make easier by supporting multiple languages in the future.”
Mental health treatment and confidential care for adolescents pose their own challenges with telemedicine. “You hope your patient has a private space, but that’s not often the case when they live in multi-generational homes or shelters — or for survivors of domestic violence,” Dr. Schweiberger says. “To work around that, we try to ensure confidentiality by including safe words, using headphones, and even turning their phone around to show the room they’re in. Unfortunately, it isn’t a perfect system, but these steps help to ensure confidentiality as much as possible.”
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