Digital health equity

Telemedicine expands health care access for patients facing barriers to in-person care but may also inadvertently widen existing care disparities for the 25 million people living in the US with limited English proficiency (LEP). In this large, diverse sample of patients seeking primary care during the COVID-19 pandemic, one-third of patients with LEP scheduled a visit by video instead of telephone. Patients with LEP chose video less often than patients without LEP, but, among patients with video visit experience, no significant difference in video visit use by LEP was found, suggesting that once patients with LEP have video visit use experience, they are not different from patients without LEP in likelihood to reuse video visits.

We looked at the associations of patient language and patient-provider language concordance (i.e., speaking the same language) with telemedicine visit type (video or phone visit). Compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese, Mandarin, and Vietnamese, and lower among those speaking Punjabi. Language concordance was associated with lower video visit use. Disaggregating patient subpopulation data is necessary for identifying those at greatest risk of being negatively impacted by the digital divide.

This study evaluated factors associated with successful video visit connections in a hospital system with 4.5 million members. We found that  medical assistant–supported virtual rooming (i.e., connecting with the patient before the physician connects) was associated with successful video visit connections in this diverse population. High medical assistant rooming rates were associated with better connection improvements for patients at higher risk of not connecting, including those with lower SES, of Latino ethnicity or African American or Black race, or those needing interpreters. Medical assistant–supported virtual rooming merits further testing as a possible means of narrowing the digital divide.

In this qualitative study, we interviewed hospital leaders, primary care physicians, service managers, and medical assistants about the strategies used to facilitate the successful delivery of video visits to populations negatively impacted by the digital divide. Key strategies for sustained video care adoption included clinical leadership articulating its purpose, multidisciplinary collaboration, local innovation, effective data use, empathy, and personalized care. These findings provide a model for how health care systems can foster robust adoption of technologies in a more equitable way.