Doctor Holding Cell Phone. Cell phones and other kinds of mobile devices and communications technologies are of increasing importance in the delivery of health care. Photographer Daniel Sone.

Viewing Telehealth Policymaking Through the Lens of Disability

Join us on Wednesday, April 7 for further discussion of these issues during our virtual event, “Triumphs & Tensions of the Telehealth Boom.

By Laura C. Hoffman

As a means for delivering health care, telehealth will only be as successful as it is accessible to our most vulnerable populations.

Although the utilization of telehealth has the great potential to increase access to health care while simultaneously reducing barriers to access for individuals, people with disabilities face multiple barriers to telehealth. The COVID-19 pandemic has further highlighted these challenges.

When telehealth became a primary means of accessing health care during the pandemic, people with disabilities who had difficulties using technology could not easily transition to virtual visits.

Many people with disabilities lack the necessary technologies in order to use telehealth. Compared to people without disabilities, the disabled are 20% more likely not to have access to a computer, smartphone, or tablet.

Other populations, such as the elderly, also are impacted by the digital divide, which points to the importance of acknowledging and addressing this issue in policy development.

The digital divide encompasses not only issues of access to Internet and devices, such as a laptop of iPad, but also issues concerning accessibility.  For example, individuals who use assistive technologies may have compatibility issues with websites that are inaccessible.

Further, tele-visits typically require both audio and visual components. This presents obvious challenges to people with disabilities that affect their hearing and/or seeing. While telephone or audio-only versions of tele-visits may be a potentially useful option for many with disabilities, as well as other vulnerable populations, this modality is heavily debated within the telehealth policy landscape.

Despite the existence of both federal anti-discrimination law and federal health care protections for people with disabilities, there are concerns that telehealth will remain inaccessible to the disabled. Federal action on this front is lacking; for example, the U.S. Department of Justice has yet to issue guidance with respect to website accessibility regulations under Title III of the Americans with Disabilities Act (ADA).

Any future policies regarding telehealth should fully examine the challenges people with disabilities face to ensure inclusivity of this population. People with disabilities already must contend with existing health care disparities; the digital divide poses a risk of doubling these disparities.

Will the technology be designed in ways such that people with various disabilities can use it?  Are different modes of communication accessible and standardized, such as the use of sign language interpreters and closed-captioning?

Privacy concerns may also be more severe for people with disabilities, requiring the reexamination of U.S. privacy law to ensure appropriate measures are taken to protect the health information of the disabled.

Also, research is still needed to address the potential impact of the use of telehealth for people with disabilities living in rural areas.

By examining these challenges and developing strategies to respond, other marginalized populations who are often embedded within the disabled population may also benefit, including the elderly, racial and ethnic minorities, non-English speakers, and individuals of lower socio-economic status.

According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 4 in the U.S. live with a disability, and most people will experience disability at some point in their lives.  In light of the long-term health consequences of COVID-19 infections, there may be even more people with disabilities in the immediate years to come.

There are clear benefits to telehealth use for people with disabilities, including reduced transportation costs, improved communication regarding medication management, limited potential exposure to communicable diseases, and reduced need for paid personal assistant services. People with intellectual and developmental disabilities (IDD) have benefited from access to health care through the use of telehealth services during the pandemic, a promising area for future exploration and advancement.

When disability is at the forefront, rather than an afterthought, of policy development, not only will telehealth services benefit, but even more significantly, so will the health care of the many other populations that are likewise at risk of being left behind.

Laura C. Hoffman is a Senior Research Fellow with the Solomon Center for Health Law and Policy.

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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