Overlooked: Improving telehealth for those who have trouble seeing

Telehealth is changing the nature of healthcare, but millions of Americans with visual impairments could be missing out on the benefits.

While providers are using telehealth far more than they did before the emergence of the COVID-19 pandemic, the healthcare industry must make virtual care more accessible to those with difficulty seeing, researchers from the University of Houston wrote in an article in Health Affairs Forefront.

“Currently, there is no all-inclusive telemedicine software that permits independent use for persons with VI,” the researchers wrote. “The lack of accessibility tools prevents patients from freely scheduling appointments or navigating e-visit portals.”

Some individuals with visual impairments have also found difficulties because videos lacked captions, services didn’t have text alternatives for pictures, or required a mouse for navigation, the authors wrote.

While health systems can deliver telehealth via video or audio, many services are best delivered by video, providers say. And even those with visual impairments want to access video services.

The American Foundation for the Blind found those with visual impairments have struggled accessing telehealth services. The federation put out a report that said 70% of those surveyed attempted to use telehealth services, and 57% of those respondents said they had trouble accessing those services.

As more hospitals and health systems use telehealth, offering services for those with visual impairments is not a small consideration. More than 7 million Americans had some kind of visual acuity loss in 2017, and about 1 million Americans are blind, the researchers state.

While some telemedicine software programs provide assistance, the researchers wrote, “most platforms are not created with an accessibility-based design, leaving some users without support. Furthermore, most telemedicine portals lack essential tools such as screen readers, magnification, and high-contrast software—all typical applications used by the visually impaired community.”

The U.S. Department of Justice issued guidance for nondiscrimination in telehealth for those with disabilities, although those recommendations were just released in July 2022.

The guidance cites examples of difficulties, including patients with blindness or limited vision having difficulty with web-based telehealth platforms. The Justice Department guidance states, “A health care provider’s failure to take appropriate action to ensure that care provided through telehealth is accessible can result in unlawful discrimination.” Reasonable accommodations could include a sports medicine practice that uses videos for physical therapy should include audio descriptions for patients with visual impairments, the guidance states.

While the federal government has issued the guidance on access in telehealth, it’s not clear how it will impact clinical practice, the researchers wrote.

Telemedicine has shown to be an invaluable tool in healthcare, providers say. Telehealth services helped reduce the risk of overdoses requiring medical treatment, according to a recent federal study published Aug. 31 in JAMA Psychiatry.

Yet studies have also found some disparities emerging in telehealth. Earlier this year, the U.S. Department of Health & Human Services issued a report that found Black, Asian and Latino patients were less likely to use video telehealth services than white patients.

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Researchers suggested the designers of telehealth programs should ensure compatibility with assistive technology devices. They also pointed to the need to allow multiple users, such as a family member or a specialist, to participate in a telemedicine appointment if more assistance is needed.

Health systems and hospitals can help patients by ensuring their needs are met before appointments, including any issues with technology, the authors wrote. Providers should connect with patients ahead of the appointment to see if they’ll need audio recordings or other digital formats. Patients with visual impairments would benefit from text transcription in real time, while family members should be offered printed material, the authors wrote.

Hospitals must be careful to ensure telehealth offerings, however well intentioned, don’t expand disparities in healthcare, said Evelyn Terrell, the director of telehealth and special projects for the Nicklaus Children’s Hospital in Miami, Florida.

At the HIMSS Global Health Conference in March,  she said providers should be sure to have telehealth offerings designed for people of different ages and those with different languages.

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

In this short video, Evelyn Terrell spoke with Chief Healthcare Executive about making telehealth accessible.