Jaspal Singh, MD, MHA, MHS, on How Telemedicine Can Help With Health Care Disparities

Jaspal Singh, MD, MHA, MHS, initially thought that telemedicine would widen the digital divide. But in this video, Dr Singh explains how telemedicine has actually had positive effects on patients from disadvantaged populations, including decreased no-show rates and increased access to providers.

Jaspal Singh, MD, MHA, MHS, is medical director of both pulmonary oncology and critical care education at Atrium Health and a professor for the Carolinas HealthCare System in Charlotte, North Carolina.

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Jaspal Singh: I’m a medical director of pulmonary oncology at Atrium Health as well as medical director of critical care education for our health system. I’m in Charlotte, North Carolina. 

Today I wanted to talk about telemedicine as far as how it affects, I think, our most disadvantaged population. I think when I first started doing telemedicine, one of the things that I thought was that what we talked about the digital divide would hold true—that basically people of certain demographics with, you know, lower education status, lower income status might be at more of a disadvantage. I was actually really surprised to learn that, in practice, actually what we’re finding is almost the exact opposite in many areas. And that’s been really exciting to see. So now that virtual medicine is sort of accepted and a lot of us are using it and across all disciplines, it’s been really interesting to watch this particular population, subpopulations involved, actually. Those are the lower socioeconomic, for example, the patients who are Medicare, Medicaid or have access issues, especially very fascinating because a lot of them—in some of our clinics—we saw pretty high no-show rates prior to COVID-19 and the virtual sort of onslaught. And what we’re seeing now is actually a lot of those clinics—now that we can reach these patients by phone, by virtual visits and virtual consultations or virtual check-ins are reimbursed—from a pulmonologist perspective, we’ve actually had a substantial improvement in their show rates. 

You may ask, well, why is that important. Well, of course, number one, it’s more efficient for the clinic. But number two, now a lot of these patients had to, you know, take the bus, take public transportation, take multiple stops, get someone to drive them, their transportation may not have been reliable. And on top of that, you know, they may not see the physician visit as valuable as some of the other populations might. Or they may not see it as an important part of their day; they might have jobs that they’re trying to hold on to it. They may have other income pressures that many of us don’t realize they have. They can’t just get away for a 15-minute office visit during the day, which may take them a certain amount of time to wait in the office to get other things done. And so what we’re finding is that the no-show rates, the access actually potentially improved. Now you can also give them touch points more frequently in terms of, I can call them and go over, you know, not just virtual visit, one, will be kind of discussing their symptoms and getting things started and then they can send them for pulmonary function tests later or chest X-ray later, and now they understand why they’re going to the next step. And then rather than sort of waiting for the results of all that stuff to kind of collate and then follow up with them later, we can touch base with them on a more regular cadence, at their own convenience, around their schedule a little bit more than we have been. Many of us, when we serve these populations may be backed up for months to take care of them, and they can’t get back in and they have to reschedule, and they have frequent rescheduling issues. Those issues are a lot better now managed through a virtual clinic, which I thought was really interesting.

Don’t get me wrong, there’s still a digital divide. I mean, having seen patients, you know, hold the camera upside down. The other day I saw sleep consult while patient was driving, which kind of freaked me out a little bit, like, why are you driving and on the camera? And then sometimes you’ll see some really bizarre social dynamics. That being said, sometimes, for example, my patients will speak a foreign language. Now they’ll have a loved one in the room, for example, with them when I call that because they love one doesn’t take time off, like a daughter, or a son, or grandchildren that can actually help them line up the camera, follow-up on instructions, makes sense of what’s happening, and explain it to the patient. So now it can engage—especially when other clinics have become so that we’re limiting visitors, having that extra family person or a friend around the time of the visit can be very helpful. I spoke with one patient this morning via virtual check-in, and it was really helpful for the friend who is taking care of the elderly loved one, of their loved friend, and was able to coordinate all the care that the patient could not process. And so, bottom line is, I think the story is not complete without understanding the value of our most disadvantaged populations in virtual care. 

So I’m hoping that virtual care stays. I get it, there’s all kinds of financial pressures, there’s efficiencies around us for clinic visits. It’s a lot of work on the part of the staff and our clinicians, but for some reason, it’s really creating a lot of value in those populations and it has to get a lot of attention. So I’m hoping that continues to do so.

Now in COVID-19, particularly, that’s really important because as we know the prevalence in incidence of COVID-19 respiratory infections is probably higher in this population. So we’ve tested this populations, and we’re finding that they’re even more susceptible to some of these infections. So getting to them quickly, getting them at a time that’s convenient and not having to touch them is actually very helpful for the population management of these patients, and understanding sick context, understanding how to get them when they’re living in multigeneration homes and all those kinds of social situations. So for these populations, I’m hopeful that virtual care will be here to stay.

There are obviously some financial concerns and some financial implications for all these, but we hope that you’ll adopt telemedicine, particularly from that perspective because I really find this a lot of value in our most disadvantaged populations.