Telehealth and digital health innovations: A mixed landscape of access

Abstract

In the wake of emergent natural and anthropogenic disasters, telehealth presents opportunities to improve access to healthcare when physical access is not possible. Yet, since the beginning of the COVID pandemic, lessons learned reveal that various populations in the United States do not or cannot adopt telehealth due to inequitable access. We explored the Digital Determinants of Health (DDoHs) for telehealth, characterizing the role of accessibility, broadband connectivity and electrical grids, and patient intersectionality. In addition to its role as an existing Social Determinant of Health, Policies and Laws directly and indirectly affect these DDoHs, making access more complex for marginalized populations. Digital systems lack the flexibility, accessibility, and usability to inclusively provide the essential services patients need in telehealth. We propose the following recommendations: (1) design technology and systems using accessibility and value sensitive design principles; (2) support a range of technologies and settings; (3) support multiple and diverse users; and (4) support clear paths for repair when technical systems fail to meet users’ needs. Addressing these requires change not only from providers but also from the institutions providing these systems.

Telehealth Availability for Mental Health Care During and After the COVID-19 Public Health Emergency

“…While only 2.6% fewer MHTFs were offering telehealth after the PHE, there was lower adoption and higher discontinuation of telehealth in public than in private MHTFs, suggesting that publicly owned MHTFs may face additional barriers to telehealth promotion. This finding is consistent with recent studies in the literature …”

“…This finding is consistent with recent studies in the literature. 13,14 In addition, we found that MHTFs offering telehealth at wave 2 were providing more limited services-for example, more frequently requiring video-based telehealth, declining services for comorbid AUD, and placing limitations on availability of telehealth services for psychotherapy and medication management compared with wave 1. One potential explanation for this is that the end of the PHE may have had a chilling effect on clinician behavior; during the COVID-19 pandemic, HIPAA and regulatory agencies offered broad discretion to clinicians to encourage telehealth utilization for nonemergency services.…”