Telehealth in underserved populations needs telecommunication expansion [PODCAST]

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“COVID-19 has propelled the nation into widespread telehealth services to provide consumer-based care, especially for those who access this technology. Equity issues arise when using digital communication because many underserved populations lack access to digital and/or mobile services. Inevitably, this brings up the greater concern of an unintentional exacerbation of disparities because low-income groups face limited access to both computers, mobile services, and the internet. Hence, investing in access to the internet and smartphones should be prioritized for underserved populations. As telehealth expands, broadband providers and municipal broadbands will cater to the demands in unserved areas by expanding their internet services.”

Sammi Wong is a medical student. Krysti Lan Chi Vo is a psychiatrist.

They share their stories and discuss the KevinMD article, “Telehealth in underserved populations needs telecommunication expansion.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Sammi Wong and Krysti Lan Chi Vo. Sammi is a medical student. Krysti is a psychiatrist, and together, they wrote the KevinMD article “Telehealth in underserved populations needs telecommunication expansion.” Sammi and Krysti, welcome to the show.

Sammi Wong: Thank you for having us on your podcast.

Kevin Pho: We’ll get into your article in a little bit, but first off, I’m going to ask each of you to share your story and your journey to where you are today. Sammi, why don’t we start with you?

Sammi Wong: I’m a second-year medical student based in New York, and I have a growing interest in child and adolescent psychiatry. That kind of spearheaded me toward telepsychiatry, which is where I came into contact with Dr. Vo, who has expertise in this area.

Kevin Pho: Wonderful. And Sammi, how is the pandemic affecting your medical training?

Sammi Wong: Right now, it’s OK. I’m in a little mix, a hybrid of virtual education and also in the lab. So we’re all adjusting to this pandemic, which is good.

Kevin Pho: Wonderful. And Krysti, can you share your story and your journey to where you are today?

Krysti Lan Chi Vo: I am a board-certified adult and child and adolescent psychiatrist. When I got out of my training, I knew, and predicted, that telepsych would be where the future is. So I took a position at Children’s Hospital of Philadelphia as their medical director of telehealth, and I helped build their clinical services and strategy for telepsychiatry.

And so when Sammi came to me and asked me to think about how we could write together, I figured this is a great time for putting together pieces that really address telehealth, and to use it as a kind of advocacy piece, for grassroots awareness as well as for promoting it to legislators for advocacy.

Kevin Pho: Krysti, we are speaking in the third week of January. Tell me about the types of cases that you’re seeing in your practice as it relates to the pandemic.

Krysti Lan Chi Vo: Well, there’s actually an increase in mental health crises in our children’s hospital, in our ER. My partners and colleagues in New York hospital ERs also see this increase, and nationwide, there’s a major increase. I think that’s because, despite the pandemic and the risk of going to crisis centers, people are really so desperate in their mental health that they are going. And that shows a lot about how maybe the mental health crisis is the underlying secondary pandemic as a result.

Kevin Pho: All right, so let’s talk about your KevinMD article that both of you wrote, “Telehealth in underserved populations needs telecommunication expansion.” Sammi, for those who didn’t read the article, can you just walk my audience through it and share the story of why you and Krysti decided to write it?

Sammi Wong: Yeah, sure. Within the telehealth space, there are hotspots within the communication expansion, and inevitably, the lack of internet as well would create health disparities. So we took this as an opportunity to advocate for greater awareness of such digital equity issues, which have become increasingly prominent, especially during the COVID pandemic, when essentially Wi-Fi is what everyone needs. So this article serves to inform the public that better infrastructure is needed, especially in these underserved and rural areas, to promote better internet connectivity and better telemental health.

Kevin Pho: And Sammi, what are some of the obstacles that people in rural areas, or people in underserved populations, have that prevent them from getting adequate internet access?

Sammi Wong: Before doing a lot of market research, I also didn’t know about this, but there’s such a big monopoly over these broadband internet providers that the residents in these areas have minimal choices over which internet provider, I guess, they could use. So this article shines a light on these disparities that we didn’t know about before COVID.

Kevin Pho: And Krysti, can you give examples from your practice, or stories that you’ve seen or cases that you could describe, of how these disparities are affecting psychiatric care, especially during the past year in your clinic?

Krysti Lan Chi Vo: Well, I think when clinicians see their patients, it’s obvious that there are some patients who really do have poor Wi-Fi, some patients who have very solid Wi-Fi, and some patients who don’t even have a smartphone that they can use for these telehealth visits, while some do. And I think seeing that is really a straight, in-your-face example of health disparities, and many more clinicians are seeing that.

So I think it is quite obvious, and our institution, Children’s Hospital of Philadelphia, is actually looking into who is declining telehealth. Are the people who are declining telehealth the people who are minorities, who are in a disadvantaged community, because they just can’t do it? We don’t want telehealth to really widen the health care disparity. We want it to really help narrow it.

Kevin Pho: And Krysti, when you see patients who have no internet or poor internet, yet they still need care, what are some things that you can do to help with that?

Krysti Lan Chi Vo: Well, one thing that we do, even prior to the pandemic, is telepsychiatry into primary care. That’s a clinical service that I started, where we Zoom into, and I say Zoom, we don’t really use Zoom, but we telepsych into a pediatrician’s office. The kid would go to the office and see us for the visit, and I think that strategy can help, especially in rural areas as well, where if they have bad Wi-Fi, they go to a hub where they can sit and do their visit.

Kevin Pho: So how would that work out? So the patient or the patient’s family would go to a pediatrician visit, and then you would also be in the visit virtually as well?

Krysti Lan Chi Vo: Yes, yes. And there are two models. In one model, the pediatrician is there with me, because they want to be trained. They would observe us in the interview, and they would learn more about how to manage psychiatric care. In the other model, they don’t have the time, they don’t have the bandwidth. I see the patient myself, and I treat them directly. In the first model I mentioned, where the pediatrician is involved, they actually do the prescribing. They actually take care of the patient, and I am their consultant.

Kevin Pho: Wonderful. And Sammi, what are some solutions that you can see to help reduce some of the disparities when it comes to the internet disparity, and some of the policy solutions that you think could solve this problem?

Sammi Wong: Now, because many articles kind of address these disparities, it is becoming more well known to the public, and with more advocacy, governments are stepping in by creating more competition with local broadband companies, so that it’s not only the major companies like Comcast and Charter who can offer Wi-Fi to these areas. And by creating more competition, it also lowers the internet prices that these underserved areas would have to pay for internet services.

Kevin Pho: So in terms of time frame, it sounds like something like that is pretty far off, in terms of introducing more companies that bring about competition. Do you see anything that can happen in a more near-term future that can help these people who don’t have access in the immediate future?

Sammi Wong: Yeah, it definitely would have to be more at the local government level, like within the city. And, I guess, as I think I addressed in the article, Philadelphia provides free internet access for low-income families as part of their expansion, and that’s part of how the major companies like Comcast and Charter are trying to step in to reinforce and initiate these digital equity plans of service for these communities.

Kevin Pho: I mean, you mentioned advocating a few times in terms of trying to make these changes. So what are some ways that we in health care can advocate for these changes?

Sammi Wong: Yeah, I think it’s just being more knowledgeable about what underserved areas would need, and sharing articles like these that shift the focus from the physical health care that’s needed. Mental health is also very important for these underserved areas. So building greater awareness for advocacy, I think, would be the fastest way to get things rolling.

Kevin Pho: So, Krysti, we are speaking toward the end of January, in the midst of what possibly is the worst wave of the pandemic. Now, hopefully we see some light at the end of the tunnel with the vaccines. After the pandemic, Krysti, what do you see the role of telemedicine to be, and what do you envision to be the near-term future of telemedicine after the pandemic wanes?

Krysti Lan Chi Vo: Yes, thank you. Very important question. I get this a lot. I think telehealth, and particularly telepsychiatry and telemental health, is here to stay. I think patients have gotten a glimpse of how easy it is to do. Psychiatrists and mental health professionals also think it’s convenient and love it.

And I think health care systems need to adapt, and they need to continue to sustain their services, their telemental health services, because at the end of the day, the consumer is going to go with the health care system that will have that need met, that service. So, to survive, it’s adapt or perish, is the way I say it. I do grand rounds at various institutions around the nation, and that’s my message in a nutshell. And I think that’s needed, necessary, for health access moving forward.

Kevin Pho: And Krysti, what do you see as some of the challenges that prevent that vision from happening?

Krysti Lan Chi Vo: It’s hard for health systems to adopt new technology because of the way they’re structured, because most technology is not internal. They have to pick a vendor, they have to do their due diligence, they have to do all that stuff. That’s why hospital systems are slower to adopt new technology. And then, in terms of the small clinics or the providers, it is easier for them to adopt new technology.

So I go to the grassroots level in terms of promoting telehealth, and how to use telehealth technology, to those small clinics and those providers, and I help them get onto what we call a digital front door, which is outside the scope of this talk, but that is to help them virtualize their clinical offerings.

Kevin Pho: We’re talking to Sammi Wong and Krysti Lan Chi Vo. Sammi is a medical student. Krysti is a psychiatrist, and together, they wrote the KevinMD article “Telehealth in underserved populations needs telecommunication expansion.” Sammi, what is the take-home message that you want to leave with the KevinMD audience?

Sammi Wong: Yeah, I think what Dr. Vo touched on is how telemental health is here to stay. So I do hope that, with more advocacy, and because it’s a great tool that can expand across many health care fields, it’s becoming more of an alternative for visits instead of a replacement for health care visits, because it gives a more private experience to everyone who needs it. And this will essentially reach a wider, greater patient population, from children to the elderly. So I do hope that a lot of people start utilizing it more.

Kevin Pho: And Krysti, I’m going to ask you the same question. What is the take-home message you want to leave with the KevinMD audience?

Krysti Lan Chi Vo: I think my take-home message is that if you’re a general person and a health care consumer, it’s important for you to talk to your mayor, talk to your representatives, and tell them, “Hey, I want telehealth to stay. Please write policy, or even vote for policy, that can sustain it.” For example, Pennsylvania does not even have a parity law, so payers are not even required to pay for telehealth services. So Pennsylvania citizens are at risk of not having these offerings, because hospital systems will not be able to get reimbursed for it.

And then, if you’re a clinician, think about the health care disparity that kind of does exist, and when you see your patients having issues with getting access, reach out to the local mayor as well. Do your part of the advocacy to decrease health care disparity and narrow that gap.

Kevin Pho: Wonderful. So thank you both for sharing your time and insight, and thanks again for being on the show.

Krysti Lan Chi Vo: Thank you so much for having us. We appreciate it.

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