Considering the space where human and structural infrastructure connect
In those dark, despairing early days of the COVID pandemic, we improvised quite a bit to ensure that essential health services were provided during a medical emergency. We discovered the potential of telehealth technology to bridge urban distances by creating a safe method of connecting physicians with people in the community. What we learned, though, was the safe connection was also a literal connection for people with mobility challenges.
Telehealth provided our medical residents a great opportunity to learn to care for people from a distance. That distance may only be a mile, but for someone sequestered in a senior apartment, or someone with poor ambulatory capabilities living several blocks from a bus stop, it might as well be 10 miles or 100 miles. For younger people accustomed to discussing intimate details of their lives without worrying about eye contact, the “Zoom boom” was no big deal. For an older person who may use the internet for emails, or may a Facebook account, the idea of talking a physical exam without a doctor in the room may be discomforting.
The problem is worsened by “digital poverty,” or the inability of lower income populations to access computer technology and broadband power to sufficiently power internet accounts. This is one of the new frontiers of health equity.
“The benefits of telehealth/telemedicine are considerable,” notes Dr. Ernie Yoder, director of Medical Education and medical director of Authority Health’s clinical operations. “Such technology permits more frequent contact between the health care team and patients. This improves communication and sharing of relevant information. This improves monitoring of chronic conditions and intervention for acute conditions. Patient education is also enhanced. An unintended outcome of telemedicine is the decline in missed appointments. Many missed appointments are related to unreliable transportation, so virtual clinical encounters mitigate that issue. Another benefit developing because of improved telemedicine is remote monitoring of patient data (blood pressure, pulse oximetry, blood sugar, etc.). Telemedicine also permits patient contact from almost anywhere (workplace, parked automobile, etc.), allowing patient care to occur at almost any time of day or night. An area of concern is the willingness of payers/health plans to pay for remote/virtual care. There is ample evidence that virtual care improves patient satisfaction and clinical conditions. It is likely that this care will contribute to control of chronic conditions, preventing disease progression and complications. Access to care is critical to patient outcomes. We need to persuade health plans to continue payment for telemedicine/telehealth.”
The Health Affairs blog offers a call to action for advocacy in Washington. As Congress debates infrastructure – structural and human – it’s important that health advocates promote the potential of telehealth to manage chronic disease and bridge urban distances for vulnerable populations. It’s also important that we push for broadband infrastructure that will allow urban populations the bandwidth to maintain good connections with their health providers.
Just as our work arrangements have changed during the pandemic, the ability to deliver health care has as well.