Telehealth may worsen digital divide for people with disabilities
Much has been made of telehealth's potential to bridge the accessibility gap for those who may be otherwise underserved by the healthcare systems.
But, experts said in a new paper published in the Journal of the American Medical Informatics Association this past week, telehealth may also exacerbate inequities faced by the disability community.
"There remains a pressing need to explicitly consider how changes in the prevalence and ubiquity of telehealth impact people with disabilities," wrote the authors.
WHY IT MATTERS
The paper authors noted that for some people with disabilities widespread access to telehealth services could improve healthcare.
They pointed out that coordinating transportation, arranging caregiver assistance and navigating public spaces in pursuit of in-person care can be challenging for many – not to mention the potential accessibility hurdles at clinics.
"Yet, if telehealth technologies are not designed, implemented, and contextualized within appropriate policies, these benefits cannot be realized, and instead could worsen health inequities within this population," they wrote.
Telehealth technology design remains inaccessible for many, wrote the authors. People with communication-related disabilities, for example, may not be able to use video-based services, and patient portals are not always compatible with assistive technology.
The authors outlined several design considerations for health IT, including:
- Assistive-technology compatibility and Intuitive user interfaces
- Multiple modes of communication
- Standards to enable sign language or closed captioning on the same screen as the service being provided
- Features facilitating multiple and different types of users
Implementation must also be considered, wrote the authors. They noted that the disability community is disproportionately less likely to have broadband and hardware access, and that some patients may need assistance learning how to use new forms of technology.
The paper also drew attention to the policy context around disabilities and telehealth. Legally, individuals with disabilities cannot be denied care, but there has been slow progress around enforcement of legislation mandating this equal access.
Writers also flagged the HIPAA flexibilities around telehealth. Although this relaxation of regulations has allowed for greater variety of available software to be used in virtual care, they argued that it also puts people with disabilities at higher risk of negative consequences for cyber security breaches, "given the increased probability of potentially sensitive and stigmatizing health information in comparison to their abled-bodied peers."
"Informatics professionals should endorse policies that both legislatively mandate and enforce accessibility and advocate for a thorough assessment of potential unintended consequences for people with disabilities resulting from extant policies," read the paper.
THE LARGER TREND
The authors of the JAMIA paper noted that older adults, people of color, and people with lower incomes are overrepresented in the disability community – meaning that from an intersectional perspective, addressing the technology needs of one group will likely address the needs of some people in others.
Members of Congress have put forth the need to address telehealth's digital divide for those who do not have access to broadband or technology.
"Some Americans don't have or can't afford a phone," said U.S. Rep. Robin Kelly, D-Ill., in October. "Will we allow them to be left behind in this revolution?"
The American Medical Association also acknowledged the inequities that virtual care can perpetrate, and the importance of working for policies that will address those inequities, in its recent resolution this past week.
ON THE RECORD
"Although people with disabilities are a health disparity population often overlooked in the assessment of differential impact of health information technology, consideration of and responsiveness to their unique constellation of needs is imperative in this new era of widespread telehealth," wrote the JAMIA paper authors.
"Failure to explicitly account for people with disability in the design, implementation, and policy dimensions of telehealth will lead to further marginalization and poor health outcomes for the more than 61 million Americans with disabilities," they said.