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    AAMC Telehealth Equity Catalyst Awards

    The AAMC is excited to announce the 2022 recipients of its Telehealth Equity Catalyst (TEC) Awards and Pilot Grants. The following programs and proposals demonstrate a commitment to addressing barriers associated with telehealth and health technology across clinical delivery and medical training, particularly for underserved and under-resourced communities. Through these innovative programs and others, the AAMC aims to learn how member institutions are addressing and mitigating these barriers to care and how evolving strategies and best practices can be spread across health systems to advance health care equity. For questions, please contact telehealth@aamc.org.

    2022 AAMC Telehealth Equity Catalyst (TEC) Awardees

    Program Summaries

    Johns Hopkins Medicine—Convening Cross-Sector Stakeholders to Promote Telehealth Access for Older Adults in Baltimore City and the District of Columbia

    The Johns Hopkins Telemedicine Equity Working Group, established in 2020 and consisting of diverse leadership and stakeholders from across the organization, has three aims: Identify populations experiencing telemedicine access disparities, develop and implement plans to promote more equitable care delivery, and measure the impact of these interventions on equity and outcomes. The working group has collected data across multiple projects identifying adults over the age of 65 who live in historically marginalized neighborhoods in Baltimore City and the District of Columbia as populations that need targeted interventions to increase access to digital health services due to barriers such as limited digital literacy or limited broadband internet access. To address this urgent public health issue, the working group will convene a series of stakeholder meetings over the next year to develop a systematic plan to promote telehealth access with a focus on older adults while consolidating partnerships for formal cross-sector collaboration in the coming years. Through this effort, they will develop a framework for how other academic health systems can catalyze regional collaborations to advance digital health access equity.

    University of California Davis—Addressing Health Care Inequities Using Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit

    In 2020, the University of California (UC) Davis implemented the Virtual Family-Centered Rounds Program to allow parents to be virtually present at their infant’s bedside and participate in family-centered rounds (FCR) — multidisciplinary bedside rounds for hospitalized patients with active engagement by the family. FCR is recognized as a best practice for hospitalized children, but because active family engagement is required, it has only been possible for children whose families can physically be at the bedside during rounds. In the neonatal intensive care unit (NICU), parents/guardians may experience barriers — which are particularly challenging for rural and low-income families — that limit family presence at the bedside, such as living far from the regional referral center or having travel, financial, work, or child care constraints that limit their ability to be physically present in the NICU. UC Davis will continue to evaluate and enhance the Virtual FCR Program with a focus on adoption of the program among families with limited/emergent English proficiency.

    Medical University of South Carolina—The CARES 529 Meeting Street Clinic: A Telehealth Initiative to Overcome Health Care Barriers and Increase Health Equity for People Experiencing Homelessness

    The CARES 529 Meeting Street Clinic is a telehealth-based free clinic that provides primary care at a drop-in resource center for people experiencing homelessness in Charleston, South Carolina, as a partnership between the Medical University of South Carolina (MUSC) and the Navigation Center (TNC), a community-based organization that provides housing, employment, financial, and other social services. The clinic’s use of telehealth mitigates transportation barriers, ensures rapid access to care, and is designed to foster trust and limit cost to improve health care access. Weekly clinics include medical and physician assistant students as telepresenters for a remote attending physician and in-person residents who are teleprecepted by a remote attending physician. After each clinic session, TNC staff and the student board work together to ensure that patients have received necessary medications, referrals, and follow-up and that they are connected with health insurance and medication assistance programs.

    University of Arkansas for Medical Sciences—The Arkansas Telemedicine Sexual Assault Nurse Examiner Program

    The University of Arkansas for Medical Sciences Institute for Digital Health & Innovation launched its Telemedicine Sexual Assault Nurse Examiner (TeleSANE) program in May 2021 to increase SANE-A (adult and adolescent) certified nursing access for victims in Arkansas’ emergency departments, particularly in rural and outlying areas. Prior to TeleSANE’s launch, Arkansas had only seven SANE-As to serve the estimated 1,200+ annual victims seeking care in the state’s emergency departments. Crime lab statistics indicated that only a fraction of sexual assault examinations were producing sexual assault kits submitted for analysis; many victims were not receiving needed care; and forensic evidence was not being systematically collected and submitted for analysis, eventual suspect identification, and conviction. In response, the existing SANE-As pooled resources to create TeleSANE, which leverages an existing statewide telehealth network connecting nearly every Arkansas hospital and provides equipment, education, and guidance by virtually connecting local clinicians to distant SANE-As for real-time, video-guided medical-forensic sexual assault examination support.

    Oregon Health & Science University—The Patient Portal Simulator

    Patient portals — the primary vehicle for patients to asynchronously access their medical records and schedule visits — are critical to the effective delivery of telehealth. Yet, data from the Oregon Health & Science University (OHSU) Health Disparities Reduction Core dashboards demonstrate that non-English speakers, Black patients, and seniors are significantly less likely to activate their portal accounts compared to their Caucasian counterparts. There is still a paucity of validated tools to close this gap, so OHSU has pioneered the use of high-fidelity simulated charts within the electronic health record (EHR) to train providers on safe and effective EHR use and has now expanded this to integrate the patient portal application into the EHR simulation environment. This tool will provide a test environment — which is identical to the OHSU Patient Portal — to allow patients and providers to have deliberate practice with the full functionality of the patient portal without compromising their own personal health information or adversely affecting other functionalities in the EHR.

    Medical University of South Carolina—Improving Telehealth Experiential Learning Through Virtual Reality Simulation for Patient Access, Engagement, and Equity

    Changes in the telehealth practice and teaching environments, accelerated by the COVID-19 pandemic, necessitate the creation of new modalities of training to provide experiential learning opportunities. Through this project, Medical University of South Carolina (MUSC) will build the necessary infrastructure for immersive training for an initial group of 150 learners over the coming year with an expansion in subsequent years to other learner groups and institutions across South Carolina. Training will occur in an online, virtual reality simulation that guides learners through interpersonal communication and clinical case assessment within an interactive environment. It will serve undergraduate programs (six colleges including medicine, nursing, dental, pharmacy, basic science, and allied health) through established telehealth interprofessional electives, graduate medical training through 75+ residency programs, and a statewide Regional Health Network (four regional hubs) of continuing education providers. Through this project, MUSC Center for Telehealth education experts will seek to ensure greater provider confidence, improved patient care experiences, and decreased access issues related to technology-enabled communication through learning activities that address social, cultural, and health equity issues.

    Henry Ford Health—Addressing Health Equity for Older Adults in On-Demand Virtual Care Access

    At Henry Ford Health (HFH), MyCare On-Demand Virtual Care is available to all individuals in Michigan, whether a HFH patient or not, through the MyChart electronic medical record patient portal. However, the Detroit, Wayne County, and rural communities served by HFH may have challenges accessing and utilizing these modes of care. Through this project, the HFH will expand and enhance its virtual care capabilities with an intentional focus on closing the digital divide gap among patients over 65 years old. Specifically, the project will survey existing patients with a social determinants of health assessment to include digital literacy and access to connectivity and devices; intentionally recruit and engage older patients in focus groups to better understand the barriers to telehealth use; recruit older patients as peer digital inclusion coaches to other older adults in the use of telehealth care; work with the system’s Virtual Care team and Pursuing Equity in Care Committee to build a telehealth equity dashboard; and host an open Virtual Care Equity Summit to share lessons learned and opportunities to improve, expand, and sustain virtual care opportunities in Michigan.

    2022 AAMC Telehealth Equity Catalyst (TEC) Pilot Grantees

    Program Summaries

    Oregon Health & Science University—Centering Community Expertise in Designing for Digital Health Equity

    The Community Led Equity by Design (CO-LED) program seeks to improve the design of health care systems and applications — a key aspect of digital inclusion — by leveraging the diverse perspectives of community-based organizations (CBOs) and human-centered design (HCD) to create better products that benefit everyone. The program has engaged CBO liaisons representing communities of color, older adults, and patients with limited English proficiency based on analyses demonstrating disparities in digital health utilization among these communities. CBO liaisons will serve as ambassadors to community members and the CO-LED team will serve as integrators who will facilitate health care transformation. The team will collaborate during a yearlong HCD workshop focused on re-imagining digital health and creating prototypes to promote digital inclusion in health care, and it will create prototypes for digital inclusion in health care, build capacity for design thinking within the CBOs, and strengthen relationships to continue multisector partnerships that address social and structural determinants of health and lead to health care innovations that benefit priority populations.

    Massachusetts General Hospital—Development and Validation of a Communications Curriculum for Equitable Telehealth Practice

    Despite the dramatic advances in telehealth, a competency-based educational approach to the delivery of effective and equitable care via telehealth has not been standardized nor evaluated. To address this gap, this project will work to develop a communications curriculum for health care providers who employ telehealth modalities and to be validated using a standardized patient experience designed to provide evaluation of the relevant AAMC telehealth competencies. Simulations with the use of standardized patients in medical education and within telehealth education have been utilized with success; however, this project will address practicing clinicians’ optimal communication skills for telehealth with a focus on equity and access. The proposed curriculum and pilot implementation have the following objectives: Create a curriculum to teach clinical practitioners optimal, patient-centered communication skills for telehealth practice using available best practices, guidelines, and AAMC telehealth competencies for practicing providers; incorporate broader issues of equitable access to health care that are particular to the telehealth environment (including, but not limited to, remote access to recommended treatment, access to follow-up, and health literacy and understanding); and validate this communications curriculum using a standardized communication skills rubric and trained standardized patient telehealth scenarios of varying complexity.

    Keck School of Medicine of the University of Southern California and LAC+USC Medical Center—Closing the Digital Divide by Integrating Design Thinking Curricula Into Medical Education

    In response to the national call to train clinicians to practice medicine in the digital age while learning to address critical telehealth disparities, Keck School of Medicine of the University of Southern California is piloting a new longitudinal medical education elective to train resident physicians to incorporate person-centered, design-based approaches to help close the digital divide. The course is designed to build on existing health systems science curricula by increasing knowledge of telehealth disparities within the safety net and applying creative problem-solving skills needed to address these disparities using applied design thinking. Design thinking is a human-centered approach to problem-solving using creative methods-based processes including problem discovery, iterative ideation, and implementation using principles of co-design in partnership with patients and leadership at LAC+USC Medical Center.