How NYC Health + Hospitals is creating a more equitable telehealth system — 4 insights

To provide equitable access to healthcare among different patient populations, telehealth technologies must take into account patients' diverse language preferences and different levels of technology proficiency along with workflow efficiency for providers.

During a January webinar hosted by Becker's Hospital Review and sponsored by Doximity, Félix Manuel Chinea, MD, Diversity, Equity, Inclusion, and Belonging manager at Doximity, introduced Kevin Chen, MD, Senior Director of Design and Evaluation at New York City Health + Hospitals. Dr. Chen discussed his organization's telehealth challenges, exploration of stakeholder needs, action plan, and results.

Four key insights:               

  1. At the onset of the pandemic, using telehealth, NYC Health + Hospitals had to rapidly find a way to serve diverse patient needs while providing clinicians with efficient workflows. According to Dr. Chen, the organization went from zero to 25,000 telehealth visits per week in less than two weeks. "Challenges became immediately apparent," he said. "First, 40 percent of our patients preferred a language other than English, and our initial platform did not have the ability to integrate interpreter services." In addition, patients varied in their levels of technology proficiency. "When patients and clinicians are unable to easily join a video visit, precious clinical time is lost troubleshooting," Dr. Chen added.

  2. Data collection efforts explored whether patients were getting what they needed equitably. NYC Health + Hospitals looked at how key services transferred from in-person to telehealth visits. For example, in-person visits often included a depression screening, but virtual visits did not. "We had a drop in the percentage of patients screened [for depression]," Dr. Chen said. "Since we had the data, we recognized the issue quickly and reintegrated some in-person care routines into the virtual workflow." Demographic data and community focus groups were used to check patient equity while surveys and site visits gathered patient and staff feedback. The team studied expected reimbursements to determine long-term financial viability.

  3. Implementing the right tool and creating support systems were keys to taking action. "The most important thing was getting the right tool for the job," Dr. Chen said. The new system needed interpreter services and EHR integration, text message invitation, and multiparticipant capabilities. NYC Health + Hospitals created tip sheets and videos in multiple languages, set up a 24/7 patient portal hotline, and worked with community organizations to be more culturally and linguistically relevant. "We also started a telehealth navigator program, which did proactive outreach to help patients for upcoming visits," he added. "One of the most helpful things for staff was providing shoulder-to-shoulder support. We'd send a team to go to a clinic, join its huddles, do a quick training and then float around the clinic during the day to help."

  4. An increase in the equitable use of telehealth during the Omicron wave illustrates success and sets the stage for future improvements. "Initial results showed more than a 50 percent participation rate in video visits by some groups and a clear narrowing of the gap between groups during the most recent Omicron wave," Dr. Chen said. The organization will continue to monitor metrics and feedback to fuel continuous improvement moving forward.

As one of the platforms used at NYC Health + Hospitals, Doximity has helped achieve more equity in providing telehealth services. "The future of equitable digital health solutions must understand that historic and social context matter when developing technology," Dr. Chinea said. "We have to ensure that we're thinking about equity at every stage from ideation to implementation."

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