Introduction
Since March 2020, telehealth has been a major part of healthcare delivery. Observational studies have shown that seniors, minorities, low-income, and rural Americans have proportionally greater challenges in accessing telehealth compared to their counterparts.1,2 However, strategies to overcome these challenges have not been fully addressed. Previous work has defined the various factors that can impact access to telehealth-compatible devices and telehealth overall, including income, race and ethnicity, lack of familiarity with video conferencing software, and availability of stable Wi-Fi, to name a few.3,4 The objective of this study was to understand in greater detail the challenges patients face with video visits and introduce specific strategies to address these problems.
Methods
We collected data on the technical barriers faced by patients through phone calls from a medical student-run volunteer program that assisted patients with telehealth visits through an electronic health record referral system.5 Data was collected from the University of Michigan's Department of Urology between April 7, 2022 and July 6, 2022.
Results
We contacted 47 patients during the study period. The estimated time spent with each patient on the phone was seven minutes, but varied widely based on patient needs. Our study identified four main issues faced by patients that prevent successful video visits: (1) completion of registration steps, (2) familiarity with accessing and using video conferencing software, (3) attainment of proxy access for parents of a pediatric patient, and (4) resolution of miscellaneous technical queries. We addressed these issues through a structured workflow algorithm (Figure 1), which provided patients with an opportunity to receive a live walkthrough of the steps for registering for a video visit, practice with video conferencing software, and guidance to resources and answers to any issues in the process. A summary of telehealth recommendations for clinics is described in Table 1.
Conclusion
This study provides practical guidance for overcoming the challenges that patients face with video visits. These strategies can be employed in any clinical practice to improve video visit adoption and telehealth access in patient populations where challenges may exist.
Figure 1: Volunteer Workflow Algorithm
Table 1: Telehealth Recommendations for Clinics
| Telehealth Recommendations for Clinics |
| Offer comprehensive and user-friendly instructional materials, including handouts and digital guides. These resources should provide clear step-by-step instructions that are easy to follow, ensuring patients feel informed and ready for their virtual appointments. |
| Develop informative walkthrough videos tailored for different commonly used video-enabling devices, such as laptops, tablets, and smartphones (including both Android and Apple devices). By providing device-specific instructions, patients can easily follow along and gain confidence in navigating their specific device for telehealth appointments. |
| Provide telehealth support via phone before a video visit by leveraging the assistance of various individuals, such as medical students, clerks, IT staff, undergraduate students, work study members, volunteers, and others. Importantly, only a minimal medical knowledge base is required for these individuals to effectively offer support. |
| Offer patients the opportunity to participate in practice video visits with a volunteer or staff member. |
| Establish a well-structured communication system customized to the clinic's workflow. Fortunately, there are various cost-effective modalities available that can be acquired. For instance, clerks can utilize a secure dropbox designed for handling protected health information, or utilize tools like Excel or paper forms, depending on the scale of the practice. Regardless of the chosen method of communication and documentation, it is of utmost importance to prioritize and maintain patient confidentiality. |
| Develop a clear and concise decision tree or flowchart that clinic staff or volunteers can utilize to efficiently and effectively address patient telehealth issues. |
| Utilize effective strategies during patient interactions, such as employing the teach-back method, encouraging patients to take notes, and involving caregivers when applicable. |
| Offer special training for parents or guardians to enable proxy access, and address any specific concerns related to the use of telehealth for pediatric care. |
References
1. Mobile Fact Sheet. Pew Research Center: Internet, Science & Tech. Published April 7, 2021. Accessed September 20, 2022. https://www.pewresearch.org/internet/fact-sheet/mobile/
2. Vogels EA. Some digital divides persist between rural, urban and suburban America. Pew Research Center. Published August 19, 2021. Accessed September 20, 2022. https://www.pewresearch.org/fact-tank/2021/08/19/some-digital-divides-persist-between-rural-urban-and-suburban-america/
3. Kan K, Heard-Garris N, Bendelow A, Morales L, Lewis-Thames MW, Davis MM, Heffernan M. Examining Access to Digital Technology by Race and Ethnicity and Child Health Status Among Chicago Families. JAMA Netw Open. 2022;5(8):e2228992.
4. Triana AJ, Gusdorf RE, Shah KP, Horst SN. Technology Literacy as a Barrier to Telehealth During COVID-19. Telemed J E Health. 2020;26(9):1118-1119.
5. Pichan CM, Anderson CE, Min LC, Blazek MC. Geriatric Education on Telehealth (GET) Access: A medical student volunteer program to increase access to geriatric telehealth services at the onset of COVID-19. J Telemed Telecare. Published online June 21, 2021:1357633X211023924.