Lessening the Gaps
Some institutions and individuals that are aware of disparity gaps in technology use have ideas and are taking steps to lessen these gaps.
Explore This IssueAugust 2021
Dr. D’Anza recommends directly engaging with communities. During the pandemic, University Hospitals experienced a 3,000% increase in virtual patient visits (from 11,000 in 2019 to more than 400,000 in 2020). However, the virtual option wasn’t accessible to many families the health system serves because they lacked Internet-connected devices. This led the health system to team up with a nonprofit organization called PCs for People that provides patients with resources to connect virtually with providers.
In July 2021, PCs for People donated 500 laptop computers, 500 hotspots, and three months of broadband service to University Hospital patients meeting certain criteria, such as those that are 200% below the poverty level or on a federally supported program such as Medicaid or the Supplemental Nutrition Assistance Program. In return, University Hospitals donates its used desktop and laptop computers to PCs for People for recycling and refurbishing. University Hospitals hopes to use this program as a pilot to expand to larger groups of patients and area communities.
“Many of our underserved patients don’t have proper access to the resources and technology required for our expanding telehealth options,” Dr. D’Anza said. “It’s critical to think of a patient’s well-being beyond the walls of a doctor’s office; this includes social determinants of health such as digital connectivity, which a program like this helps to address.”
Practices could also lessen the gap by employing technologies that require less of a broadband connection, such as asynchronous chat bots that allow patients and providers to communicate via texting or other technologies that can be sent through e-mail or phone apps, Dr. D’Anza said.
An article by Burks and colleagues suggested adding an equity officer to otolaryngology practices, a person who would focus on ensuring that all patients have equal opportunities and care. “An equity lens may include advocating for access to interpreters for telephone or virtual health care,” among other things, the article stated (JAMA Otolaryngol Head Neck Surg. 2020;146:995-996).
To enable telehealth visits, The Ohio State University Wexner Medical Center in Columbus has considered mailing patients a tablet that’s already equipped for virtual visits. “This may help people who are less technologically savvy,” said Aaron C. Moberly, MD, associate professor of otolaryngology.
During the pandemic, Rakesh Chandra, MD, MMHC, professor of otolaryngology–head and neck surgery and chief of rhinology and skull base surgery at Vanderbilt University Medical Center in Nashville, had an idea to construct telemedicine centers in underserved communities. “A patient could go there and have a qualified technician insert an endoscope or otoscope while an ENT in a remote location could have a live look, examine data, and make medical judgments and recommendations,” said Dr. Chandra, who has not yet implemented his idea.
Traditionally, the treating otolaryngologist operates the scope, but it’s conceivable that another provider, nurse, or technician could do it. “There is a solid precedence for non-ENTs, such as speech pathologists and mid-level providers, to introduce an endoscope,” Dr. Chandra said. “Placing the device isn’t necessarily the difficult part; what matters is seeing and understanding what you’re looking at and making good judgments about observations.”
For follow-up care, some patients could again be seen at the telemedicine center, while others might need to travel. The main barriers would be regulatory and technology infrastructure, Dr. Chandra said.