Telehealth services can increase equitable healthcare or exacerbate disparities. Telehealth services needs grew exponentially during the pandemic: the number of Medicare visits handled through telehealth increased 63-fold, from 840,000 in 2019 to 52.7 million in 2020. Behavioral telehealth visits also increased 32-fold. And while telehealth provides many advantages, it also exemplifies health disparities. Those who are limited English proficient (LEP), have lower rates of digital literacy or don’t have Wifi are at a disadvantage when it comes to telehealth.
In order to create more equitable healthcare, health plans need to create intentional strategies to address the gaps in telehealth to make it a more equitable healthcare option. Addressing these gaps can benefit for healthcare organizations and their members:
- Increase member engagement and turnout
- Decrease patient length of stays, readmissions, and costly ER visits
- Increase patient satisfaction and health outcomes
- Mitigate risks like lawsuits
- Reduce the opportunity cost of members leaving your plan or not signing up altogether
- Increase your organization’s NCQA health plan HEDIS score or other ratings
Telehealth is here to stay, so how can healthcare companies increase telehealth equity?
8 Ways to Increase Telehealth Equity Through Translation Services
The National Committee for Quality Assurance (NCQA) produced a white paper called The Future of Telehealth Roundtable, which covers opportunities and solutions to reduce health disparities in telehealth. One of the three areas they cover is “tailoring telehealth use and access to individual preferences and needs.” This area includes things like language barriers, digital literacy, and comfort level, and it provides a big opportunity to increase equity for LEP patients and their families.
The roundtable participants emphasized the importance of putting the patient first and prioritizing their preferences. Here are eight ways healthcare organizations can address telehealth inequities regarding preferences.
1. Use a Patient’s Preferred Language
For a more equitable telehealth experience, use a patient’s preferred language. This means translating content such as technology instructions and support materials, and providing an interpreter during the telehealth visit.
Provide language access along the entire patient journey, including the:
- Pre-visit – localized website, localized patient portal, translated healthcare forms and other necessary documentation, and over-the-phone interpreting for appointments and general questions
- Post-visit – translated follow-up instructions and other necessary documentation, and interpreters for verbal communication
2. Provide Culturally and Linguistically Appropriate Services (CLAS)
Language access should also include ensuring that content is culturally and linguistically appropriate. To guide health and healthcare organizations in advancing health equity, the U.S. Department of Health & Human Services created Culturally and Linguistically Appropriate Services (CLAS). CLAS is a set of 15 action steps that organizations can use as a blueprint to reduce health care disparities.
Content that isn’t just translated, but also takes into account one’s culture, helps provide an equitable healthcare experience. It can include targeted information like statistics on the specific culture instead of general information or providing pictures of people who look like the culture you’re targeting. Read the CLAS guidelines for more information.
3. Translate Digital Literacy Instructions
Equitable healthcare can also stem from making the process easy for anyone regardless of their current capabilities. A patient’s decision to participate in a telehealth appointment is connected with their level of confidence in using technology. From basic tasks like downloading an application and opening a browser to more advanced needs, a patient has to know a variety of ways to use technology.
Provide the best and most equitable possible telehealth experience by translating any digital literacy instructions, such as:
- Accessing a health portal
- Messages through a portal
- Any standalone instructions
- Technology and hardware requirements
- How to access a telehealth link and what happens next
- Troubleshooting guidelines
If you plan to provide an interpreter, make sure any guidelines are also translated and communicated with the patient before the telehealth appointment. Also, if video resources are part of the pre- or post-visit, include voice-overs in the preferred language and translated captions.
Consider running a multilingual self-audit once all these resources are in place to find and address any issues before implementing the resources.
4. Provide Telehealth Functionality for Those with Disabilities
Those with disabilities face different challenges with telehealth. For example, a person with vision impairment may not be able to view the website clearly or a person who is deaf or hard-of-hearing may require sign language capabilities or closed captioning.
Making equitable telehealth technology functional and accessible to those with disabilities increases the quality and functionality for everyone. Having features like closed captioning; a website that follows web accessibility guidelines to include white space, plain language, etc.; and providing written guidance on telehealth accessibility will make a telehealth experience better for everyone.
5. Involve Community Resources and Partnerships
Know the limited English proficient (LEP) community organizations and resources available to patients in their preferred language, and direct them to those resources when appropriate. Resources could include in-person services where patients can learn more or get support, online recorded videos, print materials, government services, and other supportive initiatives.
6. Review Pre-Visit Paperwork
Pre-visit paperwork can be confusing and time-consuming for anyone. Then imagine struggling with a language barrier. Providing accurate and complete information is a must for any patient.
Analyze your pre-visit paperwork to make sure the language is clear. You can follow the U.S. plain language guidelines for language support.
Also, consider if intake questions are culturally appropriate, so it doesn’t dissuade someone from answering or getting health services. Questions that ask about ID numbers or other questions that might involve legality status should be avoided if possible.
7. Reiterate Patient Privacy
Ensure patients understand their privacy rights by providing translated HIPAA statements and privacy policies. Make sure your platforms are also HIPAA-compliant, as technology changes have sparked needs for adjustments. For example, the Office of Civil Rights (OCR) issued a Telehealth Notification in 2020 in response to the COVID-19 pandemic. This notification helped the health care industry quickly expand the use of telehealth services.
8. Review the Process and Make Improvements
Continuously monitor and adjust the process to positively impact patient-centered care for equitable healthcare. One way to do this is to provide a survey after a telehealth experience. Just like product and service reviews online, reviews can enable you to improve the process and adjust as things like technology evolve.
Conclusion: Equitable Telehealth Services
Telehealth services have many advantages, but they also face health inequities. However, healthcare organizations can implement strategic initiatives to reduce these inequities. One of the areas is putting the patient first and prioritizing their preferences.
We provide translation and interpretation services in more than 150 languages. We’ve helped numerous healthcare companies, including some of the largest providers in the nation, provide meaningful and equitable healthcare access for immigrants, provide HIPAA-compliant services for language access and accessibility compliance, and improve their communications.
For more information about our language services, contact us at [email protected] or (530) 750-2040.