Cleveland Clinic, RAND hope to tackle telehealth's digital divide
Telehealth has the potential to expand access to care to previously underserved populations.
However, it also has the possible side effect of worsening health disparities – and it's vital, stakeholders say, to make changes to address that dynamic as soon as possible.
"The pandemic brought telehealth to the forefront of everybody's mind," said Dr. Marisa McGinley, a neurologist at the Cleveland Clinic.
"But it's unmasked issues from a variety of angles," she added.
With this in mind, the Clinical and Translational Science Collaborative of Cleveland convened a half-day "un-meeting" on Friday aimed at addressing telehealth's role in expanding – or narrowing – the digital divide.
By bringing together a wide variety of experts and stakeholders, the facilitators said they hoped to trigger discussions regarding still-open questions on telehealth and to foster collaborations.
"To make sweeping change, we need to collaborate across institutions, across states, among different types of settings," said McGinley.
Among the key themes that emerged from the discussion were sustainability, accessibility and research.
With regard to sustainability, attendees acknowledged that the current state of telehealth is the product of a rapid scale-up in response to the COVID-19 crisis.
"We can all recognize that telehealth was very rapidly implemented" in many systems, said Dr. Ruth Schneider, a neurologist at the University of Rochester.
Moving forward, Schneider noted that workflow is likely to be a challenge, particularly when it comes to blending telehealth into other clinical care services. Reimbursement will almost certainly present another hurdle, with a lack of telehealth coverage possibly standing in the way of giving patients what they want or need.
Cleveland Clinic Strategic Lead for Virtual Health Steven Shook cited attendee discussions around medical license reciprocity, but noted that a national approach could lead to fragmented care if local providers aren't engaged.
He also cited the importance of affordable malpractice insurance for providers practicing over state lines.
"There is a general agreement that telehealth is not going away," Shook said.
When it comes to accessibility, the attendees emphasized education for both patients and providers – around what's possible, and what's appropriate, for virtual care.
"Resoundingly, we need to bring in community collaborators from the ground up," said Kathy Wright, assistant professor at the Ohio State University College of Nursing.
She noted the potential for involving family members or caregivers who could assist on the technical side in the telehealth process.
"Grassroots, grassroots, grassroots, to getting it done," she said.
Where research is concerned, attendees wondered how best to evaluate the benefits of telehealth: Is it appropriate to compare it directly with in-person care? How to get out of an either/or mindset, and move toward a more complementary model?
"How do we figure out if in-person care or virtual care is optimal for which populations?" posed Dr. Lisa Bard Levine, senior advisor to the chief executive officer of the MAVEN Project. "And who are we leaving behind?"
Overall, said Julie Rish, a clinical psychologist for the Bariatric and Metabolic Institute at the Cleveland Clinic, it's important to design technology from a human-centered perspective.
"Technology has been, and will be, significantly embedded in healthcare," she said.
"We're seeing numerous on-demand virtual healthcare companies come into the market," she pointed out.
And when it comes to disparities, she said, "tech has allowed us to solve for some of these challenges.
"Yet, it is not a panacea for all healthcare challenges."
Focus on Health Equity
This month we will be reporting on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.