HIMSS 2022: Using telehealth to improve equity and access

Evelyn Terrell, director of telehealth at Nicklaus Children’s Hospital, outlines ways to ensure telehealth programs aren’t leaving patients behind.

Orlando, Florida - Telehealth and digital literacy are becoming social determinants of health, according to Evelyn Terrell.

Terrell is the director of telehealth and special projects for the Nicklaus Children’s Hospital in Miami, Florida. She talked about expanding access to telehealth to ensure equitable access to healthcare at the HIMSS 2022 Global Health Conference & Exhibition.

Telehealth has surged in popularity as a result of the COVID-19 pandemic. She relayed some of the experiences at Nicklaus and offered insights and guidance for healthcare systems to ensure that telehealth is improving health equity. A federal study pointed to disparities in access to some telehealth services among members of minority groups.

She also shared some insights after her HIMSS session with Chief Healthcare Executive. (The story continues after the video.)

Ease of use

Consumers should be able to begin a telehealth appointment with as few clicks as possible, Terrell said. It should also be easy for providers.

“It’s really understanding the journey that our patients as well as our providers are going through,” Terrell said.

Working together

Nicklaus Children’s gathers feedback in developing telehealth services and evaluating the success.

A telehealth task force consists of doctors and administrators. Physician engagement in telehealth is essential, Terrell said. Doctors, who are juggling virtual and in-person visits, are encouraged to say what works and what can be improved in telehealth services. Many doctors at Nicklaus Children’s embraced the training and seized on the potential of telehealth, she said.

Nicklaus also does extensive surveys of patients, and Terrell noted patients and families also serve on advisory boards.

It’s important to have an open collaboration with patients, families, providers and other stakeholders, and “it has to be ongoing,” Terrell said.

“We’re going to continue to have that open communication,” she said.

Surveys have shown high satisfaction among Nicklaus Children’s patients using telehealth, Terrell said.

Language access

About 70% of the population served by Nicklaus Children’s Hospital is Hispanic, so the system understood the importance of having services for those who speak Spanish.

Health systems need to make sure they have services available for the preferred language of patients, Terrell stressed.

Generation gaps
Younger adults have a higher adoption of telehealth services, so healthcare organizations need to be mindful of generational differences in their digital offerings.

“We want to make sure we’re not leaving any other generations behind,” Terrell said.

Meeting expectations

Customers have relished the chance to talk with a doctor at home, and it saves some patients from having a long drive to see their physician.

Now that customers have experienced greater ease in accessing healthcare, they are also demonstrating they have higher expectations, Terrell said. Customers are less tolerant of being told they may have to wait more than a week for an appointment.

At Nicklaus, she said the organization is focused on getting patients to see doctors within 7 days.

Looking ahead, patients are going to demand convenience and immediate access. “Same-day access will be expected by many patients,” Terrell said.

Finding balance

Telehealth use peaked in the first few months of the COVID-19 pandemic at Nicklaus, and many other health organizations. Telehealth visits have dropped a bit from the peak, although virtual appointments remain far higher than before the arrival of COVID-19.

At Nicklaus, about 18% of all appointments were done via telehealth at the peak of the pandemic. It dropped to around 10%.

Terrell said she’s unsure about the sweet spot for the split between telehealth and in-person visits. “What is the ideal percentage is something we’re trying to determine,” she said.

Understand limitations

Terrell obviously endorses the power of digital health. At the same time, she said it’s important to realize it may not work for some patients.

“Telehealth is not a one-size-fits-all,” she said. “It’s not for all patients.”