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OHSU taking steps to improve access to telehealth for all

Research identifies disparities in access to what has become an enduring feature of medicine
A doctor talks with her patient through video chat on her computer at OHSU.
Laura Byerly, M.D., talks with a patient during a virtual visit at OHSU on April 10, 2020. OHSU has dramatically expanded to provide health care through telemedicine, which now accounts for 27% of all clinical visits with OHSU clinicians. (OHSU/Kristyna Wentz-Graff)

Telehealth has rocketed to new heights since the COVID-19 pandemic, but new research from Oregon Health & Science University reveals that some groups lack full access to what has become an enduring feature of medicine.

A large proportion of clinical visits to OHSU health care providers shifted to telehealth since the beginning of March 2020. However, the new study found that seniors, non-English speakers and Black patients relied more on telephone than video visits. The comparative lack of access to two-way video exacerbates other widely acknowledged disparities in access to health care among underrepresented groups.

Image of Jonathan Sachs, M.D., M.P.H. at OHSU. A man with short dark hair and facial hair, smiling.
Jonathan Sachs, M.D., M.P.H. (OHSU)

“We found a definite disparity about how some of our patients are using telehealth,” said lead author Jonathan Sachs, M.D., M.P.H., a clinical informatics fellow in medical informatics and clinical epidemiology in the OHSU School of Medicine.

OHSU is already moving to address the findings.

  • Listening: Community advisory boards will ascertain reasons people may not be making full use of telehealth tools. The boards will help to determine whether there are obstacles such as lack of broadband internet access or simply preference for in-person visits among some groups.
  • Action: Other measures include tapping volunteers, including medical students, who can act as “digital navigators” to connect with patients individually.

Telehealth – counted as visits by telephone or through two-way video conferencing – now accounts for 27% of all clinical visits with OHSU clinicians. Before the pandemic, telehealth amounted to less than 2% of all visits.

OHSU envisions telehealth as a feature of medicine that will endure after the COVID-19 pandemic abates.

“Our goal is to never go below 25%,” said Mark Lovgren, OHSU interim vice president for the Office of Digital Health. “If we’re moving toward a world where digital health is a viable option, we want to make sure everyone has access to it.”

Jeff Gold, M.D., professor of medicine (pulmonary and critical care medicine) in the OHSU School of Medicine and a co-author on the recent study revealing disparities in access, said the effort to reduce disparities in telemedicine extends across the health system. It starts by setting up digital dashboards that measure how different patient groups access services.

“We’re one of the only medical centers to do this,” he said.

Image of Derick Du Vivier at OHSU. A man with gray hair smiling.
Derick Du Vivier, M.D., M.B.A. (OHSU)

Addressing disparities starts by engaging the communities directly affected, said Derick Du Vivier, M.D., M.B.A., OHSU senior vice president for diversity, equity and inclusion. That’s why the community boards will be critical in applying the perspective of communities of color, or older adults, or those in rural areas who aren’t fully engaging with telehealth tools.

In some cases, it may be a lack of broadband internet capacity while in others it may be related to a lack of comfort or familiarity with the technology.

“It’s not enough just to identify the disparity,” Du Vivier said. “We have to improve our relationships with the community effected, because the community is going to be an extremely important aspect to any kind of solution to this problem.”

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