Equitable Telemedicine Care

Examining inequitable access to telemedicine

Opportunity

The COVID-19 pandemic required a shift in health care delivery, necessitating a new reliance on telemedicine.

Telemedicine successfully enabled patients to receive care safely amid the pandemic. However, as novel care delivery models are established, it is critical to explore their implications on equity.

Intervention

We worked with colleagues from across the health system to launch a large-scale study examining inequitable access to telemedicine. The team analyzed data for nearly 150,000 patients at Penn Medicine, all of which had been previously scheduled to have a primary care or ambulatory specialty visit between March and May 2020.

Impact

When we broke the data set down by characteristics, some clear inequities surfaced. We found that older adults, minorities, non-English speakers, and lower-income earners face inequities in accessing telemedicine. Specifically, 
  • Patients older than 55 were 25 percent less likely than the average patient to successfully participate in a telemedicine visit, with people older than 75 being 33 percent less likely.
  • People who identified as Asian were 31 percent less likely to conduct a telemedicine visit, and those who did not speak English were 16 percent less likely. 
  • Patients with lower household incomes were also less likely to conduct a video visit, with those making less than $50,000 being 43 percent less likely.
Broader research is currently underway to better understand patient and provider-specific telemedicine barriers to inform possible interventions. In the meantime, an immediate change made in response to these findings was that Penn Medicine added one-click interpreter integration for more than 40 languages for video-based interactions and greater than 100 languages for audio-based visits.
Phase 1: It might work
Collaborators

Penn LDI
Penn Cardiology
Lauren Eberly, MD, MPH
Pete Groeneveld, MD
Ashwin Nathan, MD
Amaka Eneanya, MD, MPH
Howard Julien, MD, MPH, ML
Norrisa Haynes, MD, MPH
Sameed Khatana, MD, MPH
Samuel Takvorian, MD, MS
Neel Chokshi, MD, MBA
Rebecca Anastos-Wallen, MD
Marietta Ambrose, MD, MPH, MS.Ed
Rupal O'Quinn, MD
Matthew Seigerman, MD
Lee Goldberg, MD, MPH
Daniel Kolansky, MD
Thomas Cappola, MD, ScM
Victor Ferrari, MD
Liz Deleener, MBA, BSN, RN
Bill Hanson, MD

Innovation leads

Sri Adusumalli, MD, MSc, FACC
Chris Snider, MPH
Krisda Chaiyachati, MD, MPH, MSHP
Damien Leri, MS.Ed, MPH
Katherine Choi, MD
Eugene Gitelman, MD