As telemedicine takes hold, those without technological access may be left behind.
With people hunkering down due to Covid-19, more and more services are being offered online. Grocery shopping, therapy, and even happy hours, can all be accessed from a laptop computer. While virtual soirees are by no means essential, other services are — healthcare being one of them.
As health facilities seek to minimize in-person visits, telemedicine has become a popular alternative to traditional doctor appointments. While this virtual method of care has expanded access for some, others have been shut out.
In this episode of the podcast, we explore how recent shifts in healthcare have exposed the digital divide, widening disparities between those with technological access and those without.
This episode was produced in collaboration with — and inspired by — Verizon’s Innovative Learning Program, which seeks to bridge the digital gap in education by equipping under-resourced classrooms with technology and expanded internet connectivity.
With people hunkering down due to Covid-19, more and more services are being offered online. People can grocery shop, talk to their therapist, and even attend happy hours — all from their laptop computers. While virtual soirees are by no means essential, other services that have moved online are. Think education.
Since social distancing measures were enacted, schools across the country have closed and transitioned to online learning. It’s a move that has drawn significant concern, as nearly 12 million children in the U.S. don’t have access to the internet at home.
“That inequitable status with the haves and have-nots, you can feel it in our building, you can.”
That’s Nicole Addell. She’s the principal of Newburg Middle School in Louisville, Kentucky.
“When I tell you we are ethnically, religiously, socioeconomically diverse, with over 20 languages that we have identified, we look like the little mini-United Nations. But we are also 85% free and reduced lunch.”
Two years ago her students received iPads through the Verizon Innovative Learning Program.
“If my kiddos did not have their iPad, we would look at approximately 40% of my 1,200 homes without WIFI accessibility.”
Because of the program, her students have been able to access online courses, despite classroom closures.
“We’ve had a couple of hiccups, but it’s been smooth in comparison to other schools in our district.”
The digital divide in education has drawn attention for years. Policymakers have proposed legislation and companies like Verizon have implemented programs to help bridge the gap.
But the recent shift to online platforms has drawn attention to new realms of concern: Healthcare is one of them.
Telemedicine has become a popular alternative to traditional doctor appointments as health facilities seek to minimize in-person visits. Through video chat platforms like Zoom, providers can connect with patients, manage chronic conditions, and even diagnose certain conditions, without physically seeing the patient. But, like online learning, virtual healthcare is not universally accessible.
“Fifty percent of my patients lack access to broadband.”
Dr. Kim Schwartz is the CEO of Roanoke Chowan Health Center in Hertford County, North Carolina.
“So 50% of my patients I can’t have a virtual visit with them in their home.”
The rural area is a broadband desert — like many of the country’s most remote regions. According to the FCC, 1 in 4 rural Americans don’t have access to the internet at home.
“We serve 5 counties, one of which has 11-12% access to broadband.”
In these sparsely populated communities, telecommunication companies have little incentive to install telephone lines and internet cables simply because there are fewer customers. That means rural residents are more likely to be disconnected than their urban counterparts.
Schwartz says her Chief Medical Officer has no internet or cell phone service at home. Not because she can’t afford it, but because the infrastructure just isn’t there.
“There’s no fiber, there’s no lines. There’s nothing.”
Recently, federal restrictions were lifted to allow telemedicine to be conducted over the phone, as opposed to video chat apps. That means patients can reach their provider without an internet connection at home. The move was intended to expand access to telemedicine. And for many, it has.
“What a game-changer it has been for us.”
April Cook is the Executive Director of Lake Norman Community Health Clinic — also in North Carolina.
“It’s unfortunate that it took a Covid crisis to push us into this arena because now that we’re there, the opportunities are limitless.”
For Cook, telemedicine has made it easier to reach her patients. Many struggled to make their appointments because they didn’t have a means of transportation.
“We have about 1,500 unduplicated patients. In our clinic, and I would dare say, probably, I would say 75% of those patients share a car.”
While transportation is a problem for her patients, access to technology is not. She estimates that more than 90% of her patients have a smartphone, which has made the move to telemedicine nearly seamless.
“We did not expect that it was going to be this easy.”
Other healthcare professionals I spoke with have had similar experiences.
Leah Shoval coordinates the telemedicine program for Mary’s Center — a network of health centers in Washington, D.C., and Maryland.
“We’ve been doing telemedicine at Mary’s Center since 2017, so we’ve been doing telemedicine for some time now.”
Before Covid-19, the health center would send a medical assistant into people’s homes to facilitate virtual visits, but now, that’s not an option. Because of the new rules that allow telemedicine to be done over the phone, Shoval says they’ve been still been able to reach patients that either don’t have computers at home or aren’t comfortable navigating virtual platforms.
“What we’re finding is the majority of our patient population does have access to some phone number, so at the very least, we can reach them over the phone.
But both of these health centers are located in urban areas where cell towers are scattered every few miles. In rural areas, like Hertford County North Carolina, that’s not the case.
Schwartz says that for many of her patients the nearest cell tower isn’t near enough. “Very slim wireless access, still, here.
She says reaching her patients was easier when landlines were in nearly every home, but now, many have gone wireless.
According to the CDC, less than 50% of American households have a landline, compared to 90% in 2004. While there’s still a significant percentage that has both landlines and mobile phones, the distribution is not equal across the board. The CDC reports that low-income households are 70% more likely to use cell phones exclusively.
That has created a problem for Schwartz, whose patients rely primarily on mobile phones and live in cellular dead zones. To ensure these patients still have access to care, she and her staff went beyond their typical primary care services.
“So what we’ve done with folks that don’t have access at home, don’t have the means, don’t have laptops or smartphones, we started doing parking lot hotspots.”
Patients can drive into the health center’s parking lot and receive medical care in their cars. A clinician greets them, takes their vitals, and sets them up with a tablet they use for a have a virtual visit with their provider.
But she says patients still face barriers accessing healthcare, transportation being one of them.
“Only one in four families have a working vehicle in our five counties on average.”
For Schwartz and her patients, telemedicine has presented more challenges than solutions. While there are workarounds, like parking lot hotspots, virtual healthcare remains out of reach for many.
“It’s just exposing the health disparities that have been there all along.”
She says, it has entrenched the digital divide.