A recent article in mHealth Intelligence highlights how telehealth as part of a community-based approach can overcome the digital divide and improve access to care. While ensuring access to telehealth at home is ideal, for communities without access to quality and affordable broadband, digital devices, or digital literacy issues, community-based telehealth initiatives seek to instead meet individuals in their communities to address their technology needs. Community-based approaches include creating telehealth access points in common community spaces, providing devices to those that need them, as well as integrating digital navigators and digital navigation training into overall health care delivery systems.
Two examples of community-based telehealth initiatives include efforts by the University of Rochester Medical Center (URMC) in New York, and Parkland Health in Texas. After URMC expanded telehealth services during the pandemic, they discovered patients located in their rural communities were only utilizing telehealth via audio-only modalities. The reasoning for this wasn’t lack of broadband access, rather lack of affordable access. Most individuals in the rural and impoverished communities only had internet on their cellphones, and did not want to use limited data for data-intensive video visits, especially when cellular plans generally allow unlimited talk and text time. As a result, URMC began working to set up telehealth stations at community-based facilities, ultimately partnering with Five Star Bank to do so. While other facilities, such as libraries and retailers were considered as possible access points, URMC would have had to negotiate contracts with each standalone entity, whereas negotiating with one main organization, like Five Star Bank, to implement the approach throughout satellite locations was a more scalable approach. Meanwhile, Parkland Health established a telehealth pod at a food bank to address the lack of broadband and digital device access they found limiting telehealth’s potential across their community. Utilizing a food bank as the access point allowed individuals to meet multiple care needs all at once. Implementation challenges for both health systems were also addressed using community approaches, in terms of outreach and collaboration across the community. Privacy was also a main consideration for URMC and Parkland Health’s access points, with privacy glass and soundproofing involved in the construction of the areas designated for the visits.