Telemedicine and the Future of Health Equity in Baltimore

I recently spoke at the Baltimore Equitable Access to Telehealth event hosted by the Johns Hopkins Office of Telemedicine. This event sparked discussions about the potential of telemedicine to address health disparities, both locally and globally. It is essential to recognize the role of equity in ensuring that all communities have access to high-quality healthcare, regardless of socioeconomic status, race, or location. Telemedicine will play a significant role in achieving a vision of equitable access to health care for the future.

We live in extraordinary times, and I am amazed by the power we hold in our pockets. Using a laptop, tablet, or phone, we can connect to a vast telehealth network and speak to a doctor or nurse practitioner in minutes. Yet, even as we celebrate the existence of telehealth options in various forms, we must also acknowledge that not everyone can access this transformative mode of healthcare delivery, particularly our most marginalized populations. Like many urban centers, Baltimore City faces unique challenges, which we aim to tackle head-on.

Research has shed light on this disparity. A comprehensive study conducted by the Department of Health and Human Services Office of Health Policy in 2022 revealed that individuals with the lowest incomes and education levels, as well as those aged 65 and older from Black, Asian, and Latino communities, were the least likely to benefit from telehealth services. For instance, video telehealth rates were the lowest in this segment of society.

I have dedicated the past three decades of my career to generating scientific evidence and unraveling the systemic disparities and racism that hinder healthcare access for marginalized communities. I wholeheartedly recognize the transformative power of virtual care through telemedicine. It has revolutionized access to healthcare, while early research suggests that it can contribute to vital objectives such as enhancing patient satisfaction, improving clinical outcomes, and promoting health equity.

Our trove of data and compelling case studies exemplify how telemedicine can make a profound impact, particularly for vulnerable patient populations. However, we must also acknowledge the challenges we face in effectively implementing telemedical solutions due to systemic and extrinsic factors. Although telemedicine alone cannot eradicate health inequalities, it undoubtedly plays a critical role in our collective quest for a solution.

The COVID-19 pandemic propelled the growth of telemedicine, expanding its reach in unprecedented ways. Telehealth services, including audio-video and audio-only patient encounters, experienced a surge fueled by temporary waivers and flexibilities necessitated by the public health emergency. Research conducted by me and my colleagues at the Center for Health Equity and around the country underscores that telemedicine can profoundly enhance the patient experience, improve health outcomes, reduce costs, and foster clinician well-being and health equity. Nonetheless, without adequate support, telemedicine can also pose risks, exacerbate disparities, and result in resource waste. Therefore, it is paramount to implement telemedicine with utmost care to maximize patient satisfaction, improve health outcomes, and foster equity.

Lawmakers and agencies have made payment provisions to support telemedicine services until 2024. But, to ensure the long-term success of telemedicine, policymakers, health systems, clinicians, and educators must understand what is necessary to support it. Thankfully, emerging long-term studies and clinical practice guidelines offer insight into best practices in this area.

Dr. Kendrick Gwynn, the associate director of the Urban Health Institute, and several other members of the Society of General Internal Medicine have written a position paper in the Journal of General Internal Medicine. The paper provides recommendations for expanding telemedicine services to support chronic disease management. The paper also offers guidance on establishing policies and procedures to prevent the unfair offering of telemedicine services and to ensure safe and high-quality care. I encourage you to read the paper, but the following are a few of their insightful recommendations.

Regarding policy, they state that measures must be implemented at various levels to provide comprehensive support for telemedicine. Congress should pass laws to eliminate location and site limitations and broaden the definition of telemedicine to encompass audio-only services. The Centers for Medicare and Medicaid Services should also create telemedicine evaluation and management service codes for reimbursement. Moreover, they state that we should implement policies that go beyond healthcare to ensure an end to digital redlining practices and that broadband internet becomes available to all. These are significant barriers to telemedicine in many areas, from cities like Baltimore to rural, less densely populated regions.

To enhance clinical practice, they recommend judicious use of telemedicine in limited acute care scenarios or as a supplementary tool to in-person services for long-term care relationships. They emphasize that the decision to use telemedicine should be a collaborative one between the patient and the clinician. Furthermore, health systems should collaborate with community partnerships to ensure equitable access to telemedicine services. One example of such a partnership is a program for veterans called ATLAS (Accessing Telehealth through Local Area Stations), where they set up private telehealth booths in a convenient community location (like VFW, library, or Walmart) where patients can have virtual visits.

Lastly, they offer recommendations for education, including developing telemedicine-specific educational strategies that align with accreditation body competencies for trainees and providing educators with protected time and faculty development resources.

Over time, I believe that telemedicine will improve and expand healthcare services by helping physicians cultivate trusted relationships with their patients. We must ensure that telemedicine strategies are effective and fair for all communities. Health systems need to establish data-reporting infrastructure and collaborate with community partners.

It is also vital to develop telemedicine educational strategies, competencies, and curricula for physicians in training and continuing medical education. In so doing, we will enable current and future physicians to provide patient-centered telemedicine care that advances the goals of better patient care experiences, reduced costs, improved well-being for clinicians, improved patient health outcomes, and advanced health equity in our society.

We all have a part to play in making telehealth accessible to everyone in Baltimore City. Policymakers, healthcare providers, technology innovators, community leaders, and residents must work together to achieve this goal. Today's conversations should motivate us to act and develop creative solutions, form strategic partnerships, and reform policies to improve digital equity and healthcare access in Baltimore City and elsewhere. Let us use technology to improve the health and well-being of every resident of Baltimore City.

I thank the event organizers for asking me to speak at Equitable Access to Telehealth. I hope we can continue the conversation and take action on our recommendations.

Author bio

Dr. Lisa A. Cooper is a Bloomberg Distinguished Professor and James F. Fries Professor of Medicine at Johns Hopkins University. She is also the Director of the Center for Health Equity and the Urban Health Institute. Dr. Cooper authored the book "Why Are Health Disparities Everyone's Problem?" published in 2021 by JHU Press.