A new screening tool could improve telehealth access and equity

In a new study published in JAMA network openedresearchers at Thomas Jefferson University have developed a new screening instrument to measure digital health readinesswhich will be critical in addressing barriers to telehealth adoption among diverse patient populations.

The COVID-19 pandemic has enabled many rapid changes in healthcare, including a shift toward using telehealth services across the U.S. in place of traditional in-person doctor visits. This ensured that patients continued to receive vital care while only needing access to a mobile device or computer with a webcam.

But just because a patient has a smartphone or tablet doesn’t mean they can access their health information or use other healthcare services. The differential adoption of telehealth among population groups may lead to worsening health disparities, requiring close attention to understanding and addressing patients’ barriers to telehealth use.

Previous studies have shown that telehealth use is variable depending on a patient’s digital level and health literacy, as well as other factors such as trust. Yet, no tools currently exist designed to leverage the full scope of these barriers. As such, the research team worked to develop a tool to identify and quantify the full range of factors that influence a patient’s ability and willingness to use telehealth.

“Do they rely on using technology to have private conversations, such as medical conversations? Do they have a private place where they can do telehealth?” says Kristin Rising, MD MSHP, executive director of the Jefferson Center for Connected Care and professor of emergency medicine, public health and nursing at Thomas Jefferson University, and senior author of the study.

“These are all really important aspects of someone’s willingness to participate in telehealth that are newer to the conversation and are things that we need to be able to quantify and devise interventions to address.”

The research team analyzed data from 367 patient and physician participants at a single healthcare facility in the Jefferson Health system. They first conducted focus groups and interviews to understand all the factors that make up the concept of ‘digital health readiness’. They then developed initial screening items to measure all identified factors, refined these items based on patient input, and ultimately tested use of the screener with 304 patients.

The final ‘Digital Health Readiness Screener’ consists of 24 items that measure two primary domains: technical readiness and quality of care. Participants were primarily black (47%) and male (56%), and had completed a high school diploma or a college degree (50%).

The researchers found that patients with higher levels of education and younger patients had higher technical preparedness, and that patients with high health literacy scores had higher overall preparedness.

While these questions are a good first step toward digital health equity, Dr. Rising that more work needs to be done to test this screener in different patient populations, including those who do not speak English as their first language. Significant work is needed to develop interventions specifically aimed at addressing the various barriers assessed in this screener.

“My goal is to ensure that everyone has the tools and education they need to make informed decisions about when and if they use telehealth,” says Dr. Rising. “Ultimately it will be everyone’s decision, and some people will still decide they never want to use telehealth.”

“Digital healthcare equity is something that healthcare systems are interested in, and to date there has been uncertainty about how to do this,” said co-author and public health researcher Amy Leader, who is also deputy director of the Office of community outreach from the Sidney Kimmel Comprehensive Cancer Center – Jefferson Health. We hope that this screener provides a tangible starting point”

In addition to developing this screener, Dr. Rising and her team also made direct efforts to address another barrier to telehealth use among hospitalized patients. The Jefferson Digital Onboarding Taskforce, which consists of staff and students, has been providing one-on-one support to hospitalized patients with registering and using the patient portal since early 2023.

More recently, as an extension of the Task Force, the team created the Jefferson Bedside IT Training group to provide one-on-one digital literacy training to hospital patients.

Dr. Rising hopes that this work will not only enhance patients’ skills, but can also help build their confidence in the healthcare system in general and telehealth in particular. But this isn’t the first screener Dr. Rising and her team have developed.

Dr.’s ultimate goal Rising for the Digital Health Readiness Screener is developing a shorter form for routine healthcare use.

“Ideally, we can use this screener as a standard part of healthcare in the future and target interventions to the specific needs of each person. Access, digital literacy and trust barriers all require different interventions, and this screener can help inform how we most efficiently and effectively deploy these interventions.”