Improving access to telehealth
Health care providers should incorporate methods into their practice to reach underserved patients and ensure equal access to necessary telehealth care.
Telehealth for people with disabilities
Federal disability discrimination laws like the Rehabilitation Act of 1973 (Section 504) and the Americans with Disabilities Act (ADA) prohibit discrimination against people with disabilities and call for equal access to health care services, whether in-person or via a telemedicine appointment. Equal access to telehealth can be achieved by modifying procedures and providing additional support to patients with disabilities before, during, and after a virtual visit.
Before the appointment
Send materials and assess patient accessibility and technology needs before the appointment. Include a way for patients to note any special needs when making the appointment or on an intake form in advance of their virtual visit. Consider whether some patients may need longer appointment times.
Make resources available in different formats including printed information, audio recordings, or Braille.
Make sure your website and online tools are accessible. For example, make them compatible with screen readers and offer large text sizing.
- Section508.gov offers guidance on how to create accessible digital tools and resources for testing accessibility. Section 508 is a law that requires federal agencies to make websites and technology accessible to people with disabilities. Compliance with Section 508 is only required for federal agencies, though anyone can use these resources to make their website and documents more accessible.
Communicating with patients
To get the full benefit from a telehealth visit, patients should be able to easily understand and communicate with their health care provider. Here are some things to keep in mind when communicating with patients, family members, and patient companions who are deaf or hard of hearing:
- You must provide interpreter services and communication aids to patients with disabilities and their companions free of charge. (Patients with disabilities are not required to provide their own interpreter.)
- You may only rely on a companion interpreter (for example, a friend or family member of the patient with a disability) if:
- There’s an emergency involving an imminent threat and a qualified interpreter is not available.
- A patient with a disability requests to use an adult friend or family member as an interpreter. However, you may not rely on an adult friend or family member to interpret when there is reason to believe they may be biased, unfair, or otherwise ineffective.
For additional information, see Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings and Disability Resources for Effective Communication.
Your telehealth platform
Consider ways to make your telehealth platform and services more accessible.
- Choose a telehealth platform that offers accessible features such as:
- The ability to include an interpreter on the same call with the patient and provider
- Live captions
- High-contrast display
- Automatic transcription
- Ensure staff are trained on how to utilize accessibility features.
- Provide closed captioning for all pre-recorded patient video resources.
- Use Telecommunication Relay Services as an alternative to video appointments.
- Offer video conferencing to connect to an interpreter virtual appointment for real-time sign language or oral interpretation.
Telehealth for patients with limited access to internet and devices
Many individuals do not have access to technology such as smartphones and adequate broadband internet. Without the necessary technology, accessing telehealth services is challenging, if not impossible. It is important to include more resources as part of your practice to reach these patients.
- Call patients ahead of telehealth visits to confirm they are able to attend. Find out if they are comfortable with and have access to the necessary technology.
- When possible, provide an option to have the visit by phone (landline) if needed. Before a phone appointment be sure to check billing policies and ensure you follow HIPAA regulations.
- If your telehealth platform provides built-in privacy and security, identify free internet hotspots (such as libraries, parks, and community centers) and give this information to patients before their telehealth visit. Make sure to take the necessary steps to protect patients’ health information.
Did you know?
If your patient has trouble paying for phone or internet services, they may qualify for federal support through the Lifeline program .
Telehealth for patients with limited English proficiency
Patients with limited English language skills (also known as limited English proficiency or LEP) may find telemedicine visits conducted in English difficult to understand. To address this need, all recipients of federal funding must provide meaningful access for LEP patients through language services such as oral interpretation and written translation — also a best practice for those that do not receive federal funding. In addition to providing language services, all providers should also keep in mind cultural needs that may affect care. Here are a few tips and resources to keep in mind:
- Identify the languages that your patients speak and how frequently you can expect to use language services. Based on your assessment, determine what languages are the most relevant for your practice. Create multilingual patient resources and plan for interpreter support.
- Communicate with patients using accessible materials in multiple languages. Use resources like the “I speak” cards to determine a patient’s preferred language before their virtual appointment.
Review your patient communications to decide what should be translated into other languages. To comply with federal regulations, you must translate all documents considered “vital.” This includes any information necessary to get services or benefits, or any information required by law. (For more on how to know if a document is vital, take a look at this LEP resource.) Materials to review include:
- your telehealth platform
- your patient portal
- intake forms
- prescription information
- instructions for discharge or follow-up appointments
- phone and text reminders
- Include qualified medical interpreters in LEP patient interactions as soon as possible. Ensure that interpreters are familiar with remote interpretation.
- Match the patient with a provider that is proficient in their preferred language when possible and when it will not delay care.
- Have a qualified expert available after the visit to help translate or interpret for the patient in case of additional questions via phone or email.
Telehealth for older patients
Some older patients can have extra challenges accessing telehealth services. This can be because of hearing and/or vision challenges, low skill or comfort level with technology, or cognitive impairment. You can address these issues through more patient support services, and by making patient resources more accessible. (See telehealth for people with disabilities for more details.)