TELEHEALTH ACCESS IN A MULTI-LINGUAL, UROGYNECOLOGY POPULATION

ABSTRACT

Introduction: The Covid 19 pandemic led to a rapid adoption of telehealth. But challenges include technology literacy1 and access to technology (i.e. smartphones) 2. Since our institution's implementation of the Epic Systems (Verona, WI) electronic health record, Epic MyChart (EPIC) is the patient-facing, mobile portal application. It is the primary mode for televideo visits (televisit) endorsed by the institution. However, the platform is in English, requires downloads and passwords, site navigation, and requires over 20 clicks to setup. In a non-English speaking (55%), and digital elderly (50 + yrs old)3 patient population, this may be difficult. Doximity (Doximity, Inc, San Francisco, CA) is a text message based application without passwords and takes 4 clicks to start a televisit. This population successfully utilized Doximity for 76% of the televisits prior to EPIC. Objective: This quality improvement project is to assess the type of application needed for a televisit. If an EPIC televisit does not connect, then a Doximity televisit text was sent to the patient's cell phone. If this is not successful, it is then converted to a phone visit. The secondary purpose is to assess for factors that would predict who would be successful utilizing EPIC for their televisit. Methods: All televisits scheduled from August 1-Dec 31, 2021 was deidentified to create the dataset. ed data include televisit application, age, language, the need for login help, and zip code. Statistical analysis is conducted using SAS Studio Software. Descriptive statistics are used to summarize patient and visit data. Logistic regression is utilized for binary outcomes. Chisquare, and Fischer's used for categorical variables. Results: See Table 1. 93% (n = 208) of the scheduled televisits (n = 224) were completed. No login help was needed for 27% of scheduled televisits via EPIC (average age(age) 50 years old (yo), 87% speaking English), with an additional 24% via Doximity (age 60yo, 67% speaking English). Login help was needed for a smaller proportion of Doximity visits (29%;age 69yo, 41% speak English) compared to EPIC (35%;age 68yo, 36% speak English). If Doximity was still unable to connect, a phone visits was initiated 17% of the time (age 71 yo, 24% speaking English). Factors for independent televisits include EPIC (p = 55yo (OR 0.089, P < 0.0001) are associated with a decreased likelihood that a patient will access an EPIC televisit without help. Conclusions: In this non-English speaking and older patient population, only a minority of telehealth visits are accessible via EPIC. Despite selecting out younger and English speaking patients, due to the step-wise utilization of the televisit applications (EPIC, then Doximity), older (average 60 yo) and non-English speaking patients are able to independently login for a Doximity telehealth visit. These factors decrease access to care when only utilizing the EPIC application. To improve health equity and minimize barriers for care, a televisit application's ease of use, needs to be considered when deciding on which televisit application should be utilized by an institution. And a choice of televisit applications should be offered for access to care (Table Presented).