Bridging the digital divide: The use of text message-enabled video in the public safety-net setting

To the Editor: As discussed by Bakhtiar et al,1Bakhtiar M. Elbuluk N. Lipoff J.B. The digital divide: how COVID-19’s telemedicine expansion could exacerbate disparities.J Am Acad Dermatol. 2020; 83: e345-e346Abstract Full Text PDF PubMed Scopus (29) Google Scholar threatens to disparities in medical care as a consequence of “digital divide.” Safety-net hospitals for patients on wrong side this divide.2Lyles C. Fields J. Lisker S. Sharma A. Aulakh V. Sarkar U. Launching toolkit safety-net clinics implementing during COVID-19 pandemic. Point blog, Commonwealth Fund. Posted October 27, 2020.https://www.commonwealthfund.org/blog/2020/launching-toolkit-safety-net-clinics-implementing-telemedicine-during-covid-19-pandemicDate accessed: January 7, 2021Google These settings predominantly serve vulnerable populations that tend have barriers literacy beyond those treated private institutions.2Lyles Scholar, 3Horn D. Telemedicine is booming But it’s leaving people behind. Washington Post. July 9, 2020..https://www.washingtonpost.com/outlook/2020/07/09/telemedicine-is-booming-during-pandemic-its-leaving-people-behind/Date September 25, 2020Google 4Khoong E. Nouri Lyles Karliner L. Addressing equity chronic disease management Covid-19 pandemic.NEJM Catalyst. 1https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0123Google Accordingly, patient engagement video calls has been challenging.2Lyles Video visits are associated with greater satisfaction and higher reimbursement than telephone visits.4Khoong Scholar,5D’Ambrosio Audio-only telemedicine: docs say payment falls short MedPage Today. 13, 2020.https://www.medpagetoday.com/practicemanagement/telehealth/87531Date February 2, However, participation often demands navigation web-based portal application. Such portals historically had low rates adoption among low-income, skin-of-color, non-English-speaking patients.5D’Ambrosio Correspondingly, pandemic, encounters occur significantly less frequently public health systems facilities caring middle class.2Lyles Here, we used text message link conference were unable connect via teledermatology hospital. Prior visit, sent an email instructions access utilize their (MyChart, Epic). Resident physicians then contacted at designated appointment times assess readiness conference. If able, encounter proceeded through download, register, or navigate but amenable conference, resident physician opened (Doximity). chose not do so, visit was completed telephone. relative usage quantified using level service codes televisits (Epic). From November 23, 2020 December 30, 2020, 228 televisits: 22 (10%) engaged patient-portal conferencing 129 (56%) unprepared manner link. Seventy-seven (34%) declined participate call, no internet smartphone, either application (Fig 1). use message-enabled all demographics. Notably, aged 65 years older, only one while 11 high rate activation overall did correlate ability functionality (Table I).4Khoong Limitations include single institutional experience potential coding errors.Table IPatient demographics platform visits∗Coney Island Hospital Dermatology, from 23 31, 2020.†Some may also photography.CategoryOverall§Percentage each category evaluated visits.Patient call‖Percentage communicated category.Text category.Telephone‖Percentage category.Total number encounters22822 (10%)129 (56%)77 (34%)Number active (%)143 (62.7%)22 (100%)79 (61.2%)42 (54.5%)Patient Average age (%)47.541.544.954.119-64 years194 (85.1%)21 (10.8%)118 (60.8%)55 (28.4%)≥65 years34 (14.9%)1 (2.9%)11 (32.4%)22 (64.7%) Sex (%)Female154 (67.5%)18 (11.7%)84 (54.5%)52 (33.8%)Male74 (32.5%)4 (5.4%)45 (60.8%)25 (33.8%) Race ethnicity (%)White/Caucasian47 (20.6%)1 (2.1%)22 (46.8%)24 (51.1%)Black35 (15.4%)6 (17.1%)18 (51.5%)11 (31.4%)Asian15 (6.6%)5 (33.3%)9 (60.0%)1 (6.7%)Hispanic/Latinx57 (25.0%)3 (5.3%)33 (57.9%)21 (36.8%)Other74 (32.4%)7 (9.5%)47 (63.5%)20 (27.0%) Language‡Primary language identified registration. (%)English93 (40.8%)13 (14.0%)53 (57.0%)27 (29.0%)Spanish89 (39.0%)8 (9.0%)54 (60.7%)27 (30.3%)Russian21 (9.2%)-8 (38.1%)13 (61.9%)Other25 (11.0%)1 (4.0%)14 (56.0%)10 (40.0%) Insurance (%)Commercial31 (13.7%)7 (22.6%)13 (41.9%)11 (35.5%)Medicaid54 (23.7%)7 (13.0%)37 (68.5%)10 (18.5%)Medicare23 (10.0%)1 (4.3%)10 (43.5%)12 (52.2%)Self-pay/uninsured120 (52.6%)7 (5.8%)69 (57.5%)44 (36.7%)∗ Coney 2020.† Some photography.‡ Primary registration.§ Percentage visits.‖ category. Open table new tab foundational modern teledermatology. In appropriate environment, seamlessly facilitate such encounters. enriched facilely connect. Although training these tools proven effective, resource-limited always funding staff available dedicate task.4Khoong results show readily smartphone can be useful adjunct directly engage None disclosed. How COVID-19's disparitiesJournal American Academy DermatologyVol. 83Issue 5PreviewTo recent months, closure nonessential outpatient practices prompted Centers Medicare & Medicaid Services ease regulations telemedicine. resultant rapid investment normalize mainstream increasing familiarity introduce clinical changes endure after threat subsides. Full-Text