Technology Literacy as a Barrier to Telehealth During COVID-19.

D uring the ongoing COVID-19 pandemic, there have been many fundamental changes to the health care system, one of which has been the rapid adoption of telehealth. Despite technological capability for widespread implementation before the pandemic, telehealth remained limited in many areas of the United States due to state regulations and poor insurance reimbursement. When these policies changed in March 2020 with national widespread coverage for telemedicine, traditional clinical workflows attempted to rapidly shift to a virtual format to increase social distancing and protect vulnerable patients. At our institution alone, the number of telehealth visits increased from *15 per day to >2,000 per day in a matter of weeks. As the health care system rapidly reorganized and trained physicians on how to host videoconference visits, some patients have struggled to keep up. During these changes, providers reported that many patients were struggling to access their telemedicine appointments. Patients may have difficulty navigating their devices and entering the health care system virtually. Others simply do not have devices or a stable Wi-Fi to connect with providers from home. Technology literacy and access should be viewed as a major driver of health and needs to be on a large scale. As an example, Ms. P is a 70-year-old woman with diabetes and hypertension who knows she is high risk for complications from COVID-19. Taking extra precautions, she cancelled her in-person appointments and scheduled a telehealth visit with one of her providers. She spent an entire afternoon preparing her technology for the visit, but she could not connect to the virtual appointment. Despite a proactive mindset, she had difficulty downloading the necessary software. Recognizing this barrier to care Ms. P and other patients face, we started a medical student-led volunteer initiative to help patients set up and test devices for their telemedicine appointments. We rapidly created systematic processes for recruitment, volunteer training, clinic coverage, and operational support. A standardized phone script helped students guide patients as they downloaded the proper software and understood what to expect at the time of the visit. Within a month, we have had 135 medical student volunteers commit 1,300 h and assist >5,000 patients in preparing for upcoming telehealth visits. Along the way, we have seen a wide range of patient comfort with technology that has advanced our understanding of technology literacy. One patient, a computer programmer, initially scoffed when asked whether he needed help. However, he still appreciated the tip that he received about which web browser to use to access his visit, avoiding a glitch that kept some patients from connecting. For patients low self-reported technology literacy, our impact can be great. Many patients had never downloaded a smartphone application or used videoconferencing software before their first virtual appointment. Wary of hackers and scammers, another patient was strongly opposed to telehealth and wanted to cancel his visit, but after talking about the safety of the process with a student, he downloaded the software and had a successful telemedicine visit with his provider. If a patient cannot connect to the videoconference, the provider is forced to call the patient to troubleshoot over the phone, reschedule the appointment, or simply proceed without video. Prior work has shown that the video component significantly contributes to quality and satisfaction of the visit. In addition to the technology itself, patients need to know what to expect for their telehealth appointments. Ideally, a patient will have a medication list and be in a quiet and private location at the time of the visit. Therefore, it is important to communicate these expectations beforehand to avoid a visit that takes place from the grocery store or in the car. With the ability to see patients in their own environments, we also gain insight into their lives. Using videoconferencing, it is possible to see a patient’s home, to contextualize their experiences, and to better utilize the biopsychosocial model of health. One patient was blind but wanted to use videoconferencing so that the provider could see him. A volunteer helped the patient and his able-sighted daughter navigate the TMJ-2020-0155-ver9-Triana_2P. 3d 05/18/20 9:26pm Page 1