Telehealth as a Means of Enabling Health Equity

Craig Kuziemsky; Inga Hunter; Jai Ganesh Udayasankaran; Prasad Ranatunga; Gumindu Kulatunga; Sheila John; Oommen John; José F. Flórez-Arango; Marcia Ito; Kendall Ho; Shahi B. Gogia; Kleber Araujo; Vije Kumar Rajput; Wouter J. Meijer; Arindam Basu

doi:10.1055/s-0042-1742500

Yearbook of Medical Informatics, Table of Contents

CC BY-NC-ND 4.0 · Yearb Med Inform 2022; 31(01): 060-066
DOI: 10.1055/s-0042-1742500

Special Section: Inclusive Digital Health

Working Group Contributions

Telehealth as a Means of Enabling Health Equity

Craig Kuziemsky

¹MacEwan University, Edmonton, Alberta, Canada

,

Inga Hunter

²Massey University, New Zealand

,

Jai Ganesh Udayasankaran

³Sri Sathya Sai Central Trust, India

,

Prasad Ranatunga

⁴Provincial Department of Health Services - North-Western Province - Sri Lanka

,

Gumindu Kulatunga

⁵Health Information Unit, Ministry of Health, Sri Lanka

,

Sheila John

⁶Sankara Nethralaya, Chennai, India

,

Oommen John

⁷George Institute for Global Health, UNSW, New Delhi, India

,

José F. Flórez-Arango

⁸Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health, New York, NY, United States

,

Marcia Ito

⁹Professional Master's Program in Productive Systems, Centro Estadual de Educação Tecnológica Paula Souza, São Paulo, Brazil

,

Kendall Ho

¹⁰Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

,

Shahi B. Gogia

¹¹Society for Administration of Telemedicine and Healthcare Informatics (SATHI), New Delhi, India

,

Kleber Araujo

¹²NUTES - Núcleo de Telessaúde, Universidade Federal de Pernambuco, Brazil

,

Vije Kumar Rajput

¹³Keele University, Staffordshire, UK

,

Wouter J. Meijer

¹⁴Quality Assurance eHealth, Netherlands

,

Arindam Basu

¹⁵School of Health Sciences, University of Canterbury, New Zealand

› Author Affiliations

Abstract

Summary

Objective: The goal of this paper is to provide a consensus review on telehealth delivery prior to and during the COVID-19 pandemic to develop a set of recommendations for designing telehealth services and tools that contribute to system resilience and equitable health.

Methods: The IMIA-Telehealth Working Group (WG) members conducted a two-step approach to understand the role of telehealth in enabling global health equity. We first conducted a consensus review on the topic followed by a modified Delphi process to respond to four questions related to the role telehealth can play in developing a resilient and equitable health system.

Results: Fifteen WG members from eight countries participated in the Delphi process to share their views. The experts agreed that while telehealth services before and during COVID-19 pandemic have enhanced the delivery of and access to healthcare services, they were also concerned that global telehealth delivery has not been equal for everyone. The group came to a consensus that health system concepts including technology, financing, access to medical supplies and equipment, and governance capacity can all impact the delivery of telehealth services.

Conclusion: Telehealth played a significant role in delivering healthcare services during the pandemic. However, telehealth delivery has also led to unintended consequences (UICs) including inequity issues and an increase in the digital divide. Telehealth practitioners, professionals and system designers therefore need to purposely design for equity as part of achieving broader health system goals.

Keywords

Telehealth - equity - resilience - health systems - unintended consequences

Full Text

References

References
1 Miller EA. Solving the disjuncture between research and practice: telehealth trends in the 21st century. Health Policy [Internet] 2007 Jul;82(2):133”41. Available from: http://dx.doi.org/10.1016/j.healthpol.2006.09.011
2 Cusack CM, Pan E, Hook JM, Vincent A, Kaelber DC, Middleton B. The value proposition in the widespread use of telehealth. J Telemed Telecare [Internet] 2008 Jun 1;14(4):167”8. Available from: https://doi.org/10.1258/jtt.2007.007043
3 Bokolo A Jnr. Use of Telemedicine and Virtual Care for Remote Treatment in Response to COVID-19 Pandemic. J Med Syst [Internet] 2020 Jun 15;44(7):132. Available from: http://dx.doi.org/10.1007/s10916-020-01596-5
4 Fagherazzi G, Goetzinger C, Rashid MA, Aguayo GA, Huiart L. Digital health strategies to fight COVID-19 worldwide: challenges, recommendations, and a call for papers. J Med Internet Res 2020;22(6):e19284.
5 Basu A, Kuziemsky C, de Araújo Novaes M, Kleber A, Sales F, Al-Shorbaji N, et al. Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response. Yearb Med Inform [Internet] 2021 Aug;30(1):126”33. Available from: http://dx.doi.org/10.1055/s-0041-1726484
6 Kannampallil T, Ma J. Digital Translucence: Adapting Telemedicine Delivery Post-COVID-19. Telemed J E Health [Internet]. 2020 Sep;26(9):1120”2. Available from: http://dx.doi.org/10.1089/tmj.2020.0158
7 Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc 2020;27(6):957”62.
8 Alhajri N, Simsekler MCE, Alfalasi B, Alhashmi M, Al Ghatrif M, Balalaa N, et al. Physicians' attitudes toward telemedicine consultations during the COVID-19 pandemic: Cross-sectional study. JMIR Med Inform [Internet]. 2021 Jun 1;9(6):e29251. Available from: https://medinform.jmir.org/2021/6/e29251
9 Johnsen TM, Norberg BL, Kristiansen E, Zanaboni P, Austad B, Krogh FH, et al. Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners. J Med Internet Res [Internet] 2021 Feb 8;23(2):e26433. Available from: http://dx.doi.org/10.2196/26433
10 Dorn SD. Backslide or forward progress? Virtual care at U.S. healthcare systems beyond the COVID-19 pandemic. NPJ Digit Med [Internet] 2021 Jan 8;4(1):6. Available from: http://dx.doi.org/10.1038/s41746-020-00379-z
11 Mc Kiever ME, Cleary EM, Schmauder T, Talley A, Hinely KA, Costantine MM, et al. Unintended consequences of the transition to telehealth for pregnancies complicated by opioid use disorder during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol [Internet] 2020 Nov;223(5):770”2. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002937820308310
12 Reeves JJ, Ayers JW, Longhurst CA. Telehealth in the COVID-19 era: A balancing act to avoid harm. J Med Internet Res 2021;23(2):e24785.
13 Coiera E, Ash J, Berg M. The Unintended Consequences of Health Information Technology Revisited. Yearb Med Inform [Internet] 2016 Nov [cited 2019 Nov 4];(1):163”9. Available from: http://dx.doi.org/10.15265/IY-2016-014
14 Shaw J, Brewer LC, Veinot T. Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review. JMIR Form Res [Internet] 2021 Apr 5;5(4):e23233. Available from: http://dx.doi.org/10.2196/23233
15 Darrat I, Tam S, Boulis M, Williams AM. Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge. JAMA Otolaryngol Head Neck Surg [Internet] 2021 Mar 1;147(3):287”95. Available from: http://dx.doi.org/10.1001/jamaoto.2020.5161
16 Gunasekeran DV, Tseng RMWW, Tham Y-C, Wong TY. Applications of digital health for public health responses to COVID-19: A systematic scoping review of artificial intelligence, telehealth and related technologies. NPJ digital medicine [Internet] 2021;4(1):1”6. Available from: https://www.nature.com/articles/s41746-021-00412-9
17 Clare CA. Telehealth and the digital divide as a social determinant of health during the COVID-19 pandemic. Netw Model Anal Health Inform Bioinform [Internet] 2021 Apr 3;10(1):26. Available from: http://dx.doi.org/10.1007/s13721-021-00300-y
18 Alkureishi MA, Choo Z-Y, Rahman A, Ho K, Benning-Shorb J, Lenti G, et al. Digitally disconnected: A qualitative study of patient perspectives on the digital divide and potential solutions. JMIR Hum Factors [Internet] 2021 Oct 24. Available from: http://dx.doi.org/10.2196/33364
19 Kuziemsky CE, Randell R, Borycki EM. Understanding Unintended Consequences and Health Information Technology:. Contribution from the IMIA Organizational and Social Issues Working Group. Yearb Med Inform [Internet] 2016 Nov [cited 2019 Nov 4];(1):53”60. Available from: http://dx.doi.org/10.15265/IY-2016-027
20 Maeder A, Mars M, Hartvigsen G, Basu A, Abbott P, Gogia SB. Unintended consequences of Tele health and their possible solutions. Yearb Med Inform [Internet] 2016 Aug;25(01):41”6. Available from: http://www.thieme-connect.de/DOI/DOI?10.15265/IY-2016-012
21 Harris A, Kuziemsky C. Connectivity Patterns for Supporting BPM in Healthcare. In: Advances in Information and Communication Networks [Internet]. Springer International Publishing; 2019. p. 697”703. Available from: http://dx.doi.org/10.1007/978-3-030-03405-4_49
22 Greenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for covid-19. BMJ [Internet] 2020 Mar 12;368:m998. Available from: http://dx.doi.org/10.1136/bmj.m998
23 Coiera E. Four rules for the reinvention of health care. BMJ [Internet] 2004 May 13 [cited 2021 Nov 29];328(7449):1197”9. Available from: https://www.bmj.com/content/328/7449/1197.short
24 Haldane V, De Foo C, Abdalla SM, Jung A-S, Tan M, Wu S, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med [Internet] 2021 Jun;27(6):964”80. Available from: http://dx.doi.org/10.1038/s41591-021-01381-y
25 Bradley DT, Mansouri MA, Kee F, Garcia LMT. A systems approach to preventing and responding to COVID-19. EClinicalMedicine 2020 Mar 28;21:100325.
26 Hsu C-C, Sandford BA. The Delphi Technique: Making Sense of Consensus. Practical Assessment, Research, and Evaluation [Internet] 2007 [cited 2021 Nov 20];12(1):10. Available from: https://scholarworks.umass.edu/pare/vol12/iss1/10/
27 Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol [Internet] 2021 Jul 20;11(4):116”29. Available from: https://www.wjgnet.com/2222-0682/full/v11/i4/116.htm
28 Kuziemsky CE, Gogia SB, Househ M, Petersen C, Basu A. Balancing Health Information Exchange and Privacy Governance from a Patient-Centred Connected Health and Telehealth Perspective. Yearb Med Inform [Internet] 2018 Aug;27(1):48”54. Available from: http://dx.doi.org/10.1055/s-0038-1641195
29 Alami H, Gagnon M-P, Fortin J-P. Some multidimensional unintended consequences of telehealth utilization: A multi-project evaluation synthesis. Int J Health Policy Manag [Internet] 2019 Jun 1;8(6):337”52. Available from: http://www.ijhpm.com/article_3603.html
30 Bhatia RS, Chu C, Pang A, Tadrous M, Stamenova V, Cram P. Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study. CMAJ Open [Internet] 2021 Jan;9(1):E107”14. Available from: http://cmajopen.ca/lookup/doi/10.9778/cmajo.20200311
31 Singh Bhandari S, Joseph SJ, Udayasankaran JG, Konthoujam B, Shoib S, Dutta S. Telepsychiatry: a feasible means to bridge the demand–supply gaps in mental health services during and after the COVID-19 pandemic: preliminary experiences from Sikkim state of India. Indian J Psychol Med 2020;42(5):500”2.
32 Piggott T, Orkin, A. Deconstructing the Concept of Special Populations for Health Care, Research, and Policy. Under-Served: Health Determinants of Indigenous, Inner-City, and Migrant Populations in Canada [Internet] 2018;12. Available from: https://books.google.com/books?hl=en&lr=&id=uLZwDwAAQBAJ&oi=fnd&pg=PA12&dq=Piggott,+T.+%26+Orkin,+A.+(2018).+Deconstructing+the+Concept+of+Special+Populations+for+Health+Care,+Research,+and+Policy.&ots=CsIdef79SN&sig=pBF3SYzZx0iaaAz35mSnwJuzgAE
33 Gummidi B, John O, Jha V. Continuum of care for non-communicable diseases during COVID-19 pandemic in rural India: A mixed methods study. J Family Med Prim Care [Internet] 2020 Dec;9(12):6012”7. Available from: http://dx.doi.org/10.4103/jfmpc.jfmpc_1805_20