The turbulent nature of the COVID-19 pandemic has facilitated a swift and significant increase in the adoption of telemedicine and telehealth. Web-based, link-based or mobile platforms for medicine have continued to trend upward throughout the pandemic, increasing 10-30% in the healthcare setting due to restrictions on in-person visits. Despite this fast and sudden shift, telehealth has thrived and shown plenty of promising signs for the future. The ease in which it’s been deployed, scalability, reliability and ease of use has made telehealth more desirable for providers and patients.Despite the positive outlook for telehealth, we must ask ourselves, have we thought about patients who may have difficulties using the telehealth modalities such as video visits via computer or phone? Patients with sight, hearing, neurological, psychological or attention deficit impairments may be at a distinct disadvantage when it comes to this form of healthcare delivery. Those with disabilities are a vulnerable population. Access and communication during a healthcare encounter are essential mediators of outcomes for this population. As of July 2020, approximately 61 million adults were living with a disability in the United States.
There is a broad interpretation of what a disability is. The Americans with Disabilities Act of 1990 (ADA) and Section 504 of the Rehabilitation Act of 1973, which are both Federal laws, specifically prohibit discrimination against persons suffering a disability. All providers (who are a covered entity) have a legal obligation to provide healthcare equally to all patients, whether in-person or virtually. While there is no requirement to provide telemedicine, any provider who is utilizing telemedicine must ensure equal access to all patients.
Telemedicine isn’t the only area providers need to ensure they are offering patients a level playing field. It is crucial to remember that any communication with a disabled person must be as effective as communication with any other person seeking medical treatment. This is especially true when considering mask use, which is required for an in-person visit. It is extremely difficult for children and the hearing impaired, who may need to see the provider’s face/mouth, especially those with autism or speech disabilities. Novel challenges have been exposed, many of which may persist long-term. Children with disabilities are at an increased risk for further disparities as COVID-19 restrictions continue.
Telemedicine is no longer a complement to in-person care; it’s an alternative. Several auxiliary aids and services can enhance and improve the interaction between the provider and patients with specialized needs. It is important to remember that the patient has the best insight into knowing which modality is most effective for communicating and that privacy and security are the top priorities for all telehealth visits.
Items to consider include:
- Video remote interpreting: A form of sign language that allows a deaf or hard of hearing patient to communicate via videoconferencing instead of live, on-site interpreting. Videoconferencing equipment is used at both locations (provider and patient).
- Assistive technology: Devices or equipment that can improve a patient’s Activities of Daily Living (ADLs) and enhance their ability to communicate.
- Closed captioning: The use of subtitles displayed on a television, video screen, iPhone or other visual display to provide interpretive information.
- Clear masks: Protective masks that are transparent so that the patient can read lips and observe facial expressions. The patient can also wear these, as well.
- Three-way video conferencing: Provider, patient, interpreter.
- Telecommunications relay service: Operators facilitate telephone calls between deaf and/or blind patients and providers.
- Mobile carts/poles: For iPads and other tablet devices.