To the Editor: As discussed by Bakhtiar et al, 1 telemedicine threatens to exacerbate disparities in medical care as a consequence of the ''digital divide.'' Safety-net hospitals care for patients on the wrong side of this divide. 2 These settings predominantly serve vulnerable populations that tend to have barriers to digital literacy beyond those treated in private institutions. [2][3][4] Accordingly, patient engagement in video calls has been challenging. [2][3][4] Video visits are associated with greater patient satisfaction and higher reimbursement than telephone visits. 4,5 However, participation in video calls often demands the navigation of a web-based portal application. Such portals have historically had low rates of adoption among low-income, skin-of-color, and non-English-speaking patients. 5 Correspondingly, during the pandemic, video encounters occur significantly less frequently in public health systems than in facilities caring for the middle class. [2][3][4] Here, we used a text message link to video conference with patients that were unable to connect via the patient portal during teledermatology visits in a safety-net hospital.

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