Although many otolaryngology practices were already using telemedicine and other medical technologies prior to the COVID-19 pandemic, the virus escalated the need to rely on technology.
Explore This IssueAugust 2021
“Using technology has been particularly important in our field because otolaryngologists are at an increased risk for exposure to COVID-19, which resides in the nasopharynx,” said Michael Setzen, MD, an otolaryngologist in private practice and a clinical professor of otolaryngology at Weill Cornell Medical College in New York City. “Many of our procedures generate aerosols that could potentially subject an otolaryngologist, staff members, and patients in the waiting room to the virus.”
But some Americans can’t afford a smartphone or laptop, don’t know how to use technological devices or software, or can’t get Internet connectivity or cell phone service where they live. So where does this leave them?
As the medical director for digital health at University Hospitals in Cleveland, Brian D’Anza, MD, said there has always been a “digital divide” among certain populations. “But since the onset of COVID-19, using technology has become more common between patients and providers out of necessity. For months, there was no choice but to talk with patients virtually due to mandatory lockdowns, which has worsened these disparities.”
Contributors to Digital Divides
Although technologies have proven useful in healthcare in many ways, there are significant disparity-related considerations and concerns created by the shift toward reliance on technology, said Kevin Sykes, PhD, MPH, a research assistant professor and director of clinical research, otolaryngology–head and neck surgery, at the University of Kansas Medical Center, Kansas City, Kan.
The biggest issue that remains is the incorrect assumption that everyone carries a smartphone and has consistent Internet access. When access is assumed, it’s highly likely that someone will be left behind. —Kevin Sykes, PhD, MPH
People living in low-income and rural communities may have less access to broadband, smartphones, WiFi, and other technologies that make staying connected easier. Schools and libraries in these communities have fewer resources to provide early exposure to technology, Dr. Sykes said—and many of these access points were closed during the pandemic. These communities also bear a disproportionate burden of disease in the United States.
According to Pew Research Center, 29% of adults living with annual household incomes of less than $30,000 don’t have smartphones, 44% don’t have broadband at home, and 46% don’t have computers.
When studying 401 patients in a multidisciplinary head and neck oncology team, Samantha Tam, MD, MPH, a staff surgeon in the department of otolaryngology–head and neck surgery at Henry Ford Health System in Detroit, found that patients with Medicaid, no insurance, or other public insurance had a 26% lower chance of completing a virtual visit compared to those with other insurance types. Patients with a low median household income had a 22% to 33% lower chance of completing a virtual visit compared to those with a higher median household income (JAMA Otolaryngol Head Neck Surg. 2021;147:209-211). These socioeconomic discrepancies weren’t seen in telephone visits among the same groups.
“This may be an indicator of a digital divide, as patients with low socioeconomic status may have less access to technologic resources required for virtual visits,” Dr. Tam said. “Or, it might be because insurance coverage of virtual visits may have been unclear to patients, especially at the onset of the pandemic when many patients accessed these services for the first time.”
Other populations that are at a disadvantage for using technology include non-English-speaking individuals, people who lack access to digital literacy training, patients without technical support, people with a low level of education, and those in rural areas where high-speed Internet access isn’t available.
In addition to challenges related to obtaining and using digital tools, communication in healthcare is becoming extensively more technological for multiple reasons, said Jessica W. Grayson, MD, MS, an assistant professor and director of clinical research in the department of otolaryngology–head and neck surgery at the University of Alabama at Birmingham. Some technological advances are thought to increase access to physicians, improve the ability to give opinions (for example, if pictures are provided), and accelerate clinic throughput so more patients can be seen in a timely manner.