Abby Bossart: Telehealth isn’t a cure-all if it is not available to all

(Francisco Kjolseth | The Salt Lake Tribune) Critical Care Nurse Crystal Hale connects with doctors and patients remotely from the Telecritical Care Center in Midvale. Intermountain Healthcare announced the launch of "one of the nation's largest virtual hospital services." It will involve 500 caregivers, offering telehealth services on everything from basic care to stroke evaluation and newborn critical care. The Virtual Hospital Services Testing Laboratory showcased several medical services on Wednesday, Feb. 28, 2018,.

It is now widely known that COVID-19 is not an equal opportunity infector, as Utah’s nonwhite community members account for 21% of the population and 44% of the cases.

As a response to the pandemic, the shift to the digital world for schooling, socializing and health care visits has had profound effects on us all, especially our underrepresented community members.

Many have promoted the rapid advancement and integration of telehealth services as a silver lining of the deadly pandemic. Advertisements touting the benefits of telehealth services include offering doctor visits “From the comfort of your own home,” and, “Care everywhere.”

These statements come with a privileged bias, one to which we can’t let ourselves be blind. What if your “home” is on the street and described as anything but comfortable? What if you don’t have stable internet access? What if you don’t read or write in your native language, let alone in English? What if your baseline health literacy is low? What if there is a glitch in the connection and your ability to troubleshoot is poor.

These are the questions we must be asking ourselves before jumping to the conclusion that telehealth is the answer to this pandemic that we have been searching for. Reports indicate that 15.2% of Utahns speak a language other than English at home. Many of the telehealth platforms available require an understanding of the English language for a successful visit. Internet access and technical proficiency are part of the telehealth process.

As a fourth-year medical student currently enrolled in a refugee care elective, I have witnessed some of the challenges that many refugee patients have experienced with telehealth over the past four weeks. Connectivity problems, troubleshooting issues and language barriers, to name a few.

Furthermore, if telehealth visits fail, for whatever reason, patients are left to come in person to the clinic, further increasing their risk of exposure, or avoid being seen altogether. Both subpar options.

Geoff Watts in the British medical journal The Lancet argues “any health care development that doesn’t rapidly become available to all individuals has the unintended but inevitable consequences of fueling health inequality.” It is time we recognize this issue and prioritize solutions.

An article in the Journal of the American Medical Association discuss solutions such as expanding broadband access, accommodating telehealth services for language and literacy barriers and engaging community health workers through telehealth training and technical support during patient visits.

If telehealth is the answer to help flatten the COVID-19 curve, we better make sure it is available to all of our community members.

Abby Bossart

Abby Bossart is a fourth-year medical student at the University of Utah. Before medical school, she spent several years working with the refugee population as a case manager. Next year, she hopes to pursue a residency in neurology.