A cardiologist at a hospital engages in a pre-op consultation with a patient 400 miles. (Source: Intel Free Press / Wikimedia)

Telehealth services can appear as simple as turning on your computer and downloading easy-to-use software. In reality, it is likely that millions will have trouble with its most basic functions. 

The technology usually requires broadband and a computing device. If you’ve never used either one, it’s difficult to get it right out of the gate. Over 4 million rural homes have no access to the Internet, and basic computer skills are often lagging behind. Another million technically has broadband – but it may not be strong enough to power telehealth.

“We call patients a week before their doctor visit and ask if they need help,” said Kami Griffiths, Executive Director at the Community Tech Network (CTN). “After several weeks, about 25% of the patients age 55 to 64 needed help. Now we’re starting on the older folks and we expect a lot more needing help getting to telehealth.” 

University of California, San Francisco retained CTN to train patients how to use Zoom or log-in to the hospital’s portal. 

“Furthermore, what happens if there isn’t technical support when someone has a problem with a telehealth app?” asked Peter Caplan, the managing consultant for New York-based eHealth Systems & Solutions. “Who’s training patients what to do if the Internet has a glitch? During Covid, many doctors didn’t fully understand how to properly do a virtual medical consultation.” 

Telehealth vendors have done a good job making sure their software doesn’t take up too much bandwidth and that things are easy to use. For doctors and patients, the software is the relatively easy part. 

The Two major hiccups are telehealth adoption and health literacy. 

Digital Navigators to the Rescue

In 2015 the National Digital Inclusion Alliance (NDIA) defined broadband adoption as daily access to the Internet: 

1) at speeds, quality and capacity necessary to accomplish common tasks, 

2) with the digital skills [training, digital literacy] necessary to fully participate online, 

3) on a personal device and secure convenient network

By swapping in “equitable” for “daily,” we now have a spot-on definition of the telehealth adoption. 

Several federal agencies are increasing funding for building affordable broadband networks, and the FCC has the $3.2 billion Emergency Broadband Benefit (EBB). Both could help in establishing and expanding telehealth. 

The EBB offers homes a $100 discount computers and smartphones plus a monthly $50 subsidy for Net service ($75 for tribal homes). Over one million signed up, so digital navigators truly have their work cut out for them.

“Some cities and counties assume that if 15% to 20% of residents have low or no digital literacy skills, this may seem like a small percentage,” Griffith said. “But that percentage gets larger in certain populations – those with low general literacy, older adults, rural areas, immigrants, those who lack high school diplomas.”

“Digital navigators meet with clients to assess their technology and baseline digital skills, and follow up to make sure they meet their goals.” said Shauna Edson, Digital Inclusion Coordinator for Salt Lake City Public Library. “They advise patrons how to use technology to fully participate in their communities, the economy and society. We have three part-time navigators work in the library and three full-time navigators work in our community-based organization partners.”

The library focused on the communities that have the least connectivity and those hit the by Covid. They hired people who are active in their neighborhoods who have trust and relationships built with their community. Navigators have to interact and understand people, find out what residents’ needs are, how to support them and problem solve. “Navigators can learn how to teach patrons basic computer skills,” said Edson.

Navigators Taking the Nation by Storm

Edson and the library are working with NDIA and Rural LISC on creating a model that could be replicated by libraries and community organizations nationwide. “We’re working on creating all the documents to help support this type of model in other organizations,” said Edson. “I believe there are some organizations focusing on this model just for telehealth support.”

As telehealth becomes increasingly crucial, one challenge will be assisting patrons who have older computers running apps designed for the latest models and newer generation Web browsers. “Should we support people through this process?” asked Edson. “How to get registered with your insurance or your healthcare provider before appointments, helping people understand the logistics of telehealth? I see it as essential work for libraries.”

Is there a government commitment to subsidize and support personal digital devices vital to maximize telehealth’s data-gathering? Telehealth is more than video consulting. Tools such as digital stethoscopes, thermometers, otoscopes for ear examinations, scales, blood pressure monitor, etc. You can’t bring people to the telehealth “Promised Land” and have navigators leave patrons inside the walls, but all alone.

Beth Israel Deaconess Medical Center in Boston advocates for digital navigators as part of clinical teams. 

“As the role of technology expands in healthcare, so does the need to support its implementation and integration into the clinic,” stated “The Role of Digital Navigators in Promoting Clinical Care and Technology Integration into Practice” report. “With a digital navigator, any clinic today can take advantage of digital health and [computing] tools to augment and expand existing telehealth and face-to-face care.”

The hospital’s view of digital navigators is skewed toward clinicians, but its vision is what navigators might evolve into at libraries that take on telehealth – health literacy experts for patrons. 

“Health literacy of a majority of Americans is abysmal, and nine out of 10 non-IT people actually lack the skills needed to manage and prevent disease,” said Jessica Maack Rengal, Senior Vice President of Clinical Innovation at University of North Texas Health Science Center. 

What are librarians and navigators going to do? One option: this Health & Human Services guide teaches you how to design health websites and digital health info tools for those lacking strong health literacy skills. 

Craig Settles, saved from a stroke by telehealth, pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth initiatives.

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