Equity in Virtual Care

By Matt Fisher, General Counsel, Carium
Twitter: @matt_r_fisher
Twitter: @cariumcares
Host of Healthcare de Jure#HCdeJure

The integration of virtual care into the delivery of healthcare is opening new doors for access and patient interactions. While that statement is true, it may not be universally true. Some patient populations, especially populations with disabilities or limited English proficiency, may not be able to experience the same benefits. Working to enable access for all patients should be a focus for both the developers of the virtual care tools as well as the clinicians utilizing the tools. The developments may occur both independently and optimistically in a collaborative manner.

HHS Guidance

A framing for the work to avoid unintentional discrimination in the use of virtual care tools comes from recently issued guidance by the Department of Health and Human Services. The guidance focuses on avoiding discrimination against individuals with disabilities and individuals with limited English proficiency. The aim is to provide a reminder that nondiscrimination laws apply regardless of the setting in which care is delivered or the modality used to deliver the care. The law does not distinguish between in-person or remote, so the same considerations should be applied in both settings.

Access for Individuals with Disabilities

In addressing individuals with disabilities, the HHS guidance considers both provision of access to the virtual care tools as well as ensuring effective communication. On the access front, HHS states that individuals with disabilities should not be excluded from the use of virtual care solutions. Assuming that a disability could inhibit the use of virtual care denies those patients the opportunities and benefits that may arise from the tool. By way of example, HHS considers an individual with an intellectual disability and that a clinician should not assume that such individual will not understand how to navigate the platform. Instead, each patient should be given the chance to use and it presents the chance to reframe materials or instructions to ensure that all can understand.

Related to offering access, HHS also addresses the need to provide reasonable accommodations or modifications to help support the patients use the tools. That could mean providing additional time before, during, or after a visit or allowing the patient to have additional individuals with them on a visit (really that one should not just be a telehealth accommodation as patients can have caregivers or others with them). It all comes down to understanding the needs of individual patients and working to have tools that support those needs.

Communication is another topic addressed in the HHS guidance. The focus is on individuals with visual and/or aural impairments. In both cases, integration of alternative forms of conveying the information, whether text or text to voice, may be necessary. Such measures mirror what must occur for in-person visits.

Access for Limited English Proficiency

The second primary topic addressed by the HHS guidance was enabling access for individuals that may not be proficient with English. As noted by HHS, limited Enligh proficiency support is a component of avoiding discrimination based on national origin. Promoting access means offering language assistance services. That comes in a few different flavors such as written communications in more than one language as well as interpretation services.

Again, the use of virtual care is just a different platform for delivering the same services that can occur in-person, so the same supports must be in place.

Equity in Virtual Care

With the reminders from HHS, how can virtual care provide an experience that is available to all patients? The first step is being aware of the requirements. Awareness enables development and implementation that respects how each individual may approach use of the particular virtual care tool. Pushing ahead without an awareness can create unintentional (or hopefully not intentional) blind spots because one individual may not have all of the necessary experiences to consider the full spectrum of approaches that are called for.

After awareness comes intentionality. If requirements or obligations are known, then follow-thru commitment must come to incorporate the requirements and keep evolving to remain compliant and accessible. Those efforts can be a significant amount of work, but the benefit should be worth it.

At the end of the day, the goal of healthcare is to benefit all patients and enable each patient’s health. Those goals cannot occur if all patients cannot benefit from the best or most appropriate service. As healthcare continues to undergo innovation and movement to a new continuum of care, all must be able to participate in the new continuum.

This article was originally published on The Pulse blog and is republished here with permission.