As the novel coronavirus spread across the United States this spring, the demand for telehealth skyrocketed in turn – as did concerns about patient access to virtual care. 

A new study from the Journal of the American Medical Informatics Association published this week showed that in New York City during the first few months of the pandemic, Black and Latino patients had lower odds of using telehealth versus other modalities.

This remains true, said researchers from the Department of Population Health Sciences and Policy, even after adjusting for age, comorbidities and preferred language.

"While telehealth has many benefits, especially during a global pandemic, it may create and/or exacerbate health disparities," wrote the research team.

WHY IT MATTERS

The COVID-19 pandemic has disproportionately affected people of color in the United States, with researchers flagging the serious ramifications that could arise from using potentially biased artificial intelligence models to address the coronavirus.

At the same time, patients have turned to telehealth as a way to avoid in-person transmission and address medical needs.

"Essentially overnight, as part of efforts to reduce the transmission of COVID-19, two of the major previous barriers to telehealth use – poor financial reimbursement and low provider willingness – were eliminated, thus massively speeding up adoption," wrote the researchers.

The sporadic use of telehealth before the pandemic made it difficult to determine how often it was used by different demographic groups – although, the researchers noted, "older Americans, rural communities, vulnerable populations, racial and ethnic minorities, and those with lower socioeconomic status are all groups disadvantaged by the digital divide" in general.

Using the Mount Sinai De-Identified COVID-19 database, researchers examined information from all patients diagnosed with, placed under investigation for, or screened negative for COVID-19 with any Mount Sinai system provider between March 20 and May 18. 

During the peak pandemic period in New York City, the researchers found that patients older than 65 had the lowest odds of using telehealth for COVID-related care versus going to the emergency room or an office visit.

Black and Latino patients had higher adjusted odds of using either the ER or office visits versus telehealth than either white or Asian patients.

The researchers note that a number of factors may have contributed to the findings, such as patients not having access to a usual source of care (such as a primary care physician) or being sicker.

"However, the fact that we still find significant racial/ethnic disparities between outpatient office visits and telehealth indicate there may be other issues at play," noted the researchers.

"Disparities in digital access, digital literacy, and telehealth awareness, as well as issues of cost and coverage, and mistrust of digital appointments where physical examinations, labs and vitals cannot be taken are all potential barriers to telehealth," they continued.

THE LARGER TREND

Even as telehealth use has bloomed around the country, many are still being left behind. Many stakeholders have noted the importance of expanding access to broadband as a fundamental necessity – an endeavor that may run up, as Federal Office of Rural Health Senior Adviser for Telehealth William England put it, a "hundreds-of-billion-dollar" price tag.

In areas with broadband availability, telehealth is still not always an option. As Sen. Tina Smith, D-Minn., pointed out in an interview with Healthcare IT News in June, people in cities may also lack access to the internet – or face other hurdles to accessing telehealth.

"COVID is not the great equalizer," Smith said. "It hits harder those who are already struggling, who lack access to healthcare ... because of the generational impacts of systemic racism on Black, brown and indigenous people."

ON THE RECORD

"Our findings of racial differences in telehealth use should be interpreted within the context of persistent structural racism in the U.S.,” wrote the researchers. 

"We include race as a predictor in our model because documenting racial/ethnic differences for public awareness is a necessary first step in reducing disparities, however we view race as a social construct. The formal and informal policies and interactions rooted in inequality, discrimination, oppression and exclusion, which underlie this construct and engender factors we hypothesize are contributing to our results, should also be addressed in future research," they continued.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.