This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.
Dr. Jennifer Burgess says telemedicine has helped her Commerce Township family medicine practice better reach many patients, like one older man who has developed vision problems and can no longer drive.
"We're able to do most of his visits virtually, especially if we can get his labs before the appointment," Burgess says. "Older adults may rely on caregivers for transportation. They might have more mobility issues requiring either a walker or a wheelchair. Getting into the office can be very challenging. Telehealth allows the opportunity to have a visit while keeping the patient safe and making it convenient for them."
However, Burgess and her colleagues at HFH recognize that telemedicine may be confusing, frustrating, or straight-up inaccessible for many patients – so they're working to eliminate those barriers and create an easier experience for all. As HFH staff began working to improve telehealth care for all patients, they realized that the advance of telehealth was leaving behind a whole group of older patients who find it difficult to navigate. So HFH has been developing educational tools for both providers and patients, deploying peer navigators, and more to improve telehealth for all.
To address upstream policy and infrastructure issues that create barriers to telehealth, HFH partners with the Southeast Michigan Senior Regional Collaborative
, a network of more than 35 organizations serving the needs of older adults and persons living with disabilities.
"Someone has to want to use virtual care," says Dr. Denise White-Perkins, HFH researcher and family medicine specialist. "They have to know how to use it. They have to have broadband access and the equipment to use it. They have to have a private space. Ensuring that someone has all of those things necessary for access and then a good experience requires a partner beyond the health care system."
Telehealth is here to stay — and Michigan's physicians and hospital systems are finding ways to make it more accessible to everyone, especially older adults. Brian Peters, CEO of the Michigan Health and Hospital Association
, sees benefits for both patients and providers.
"When we talked to our members prior to COVID, many of them would say that telehealth is terrific, a great tool, but a very, very small blip on the radar screen in terms of utilization by patients, that it would probably be many years away before we saw significant utilization of telehealth," he says. "Then the pandemic happened virtually overnight. The utilization of telehealth just went up through the roof."
While connecting virtually to the local family doctor or a specialist on the other side of the state may at first seem foreign or impersonal to older folks, health, mobility, and transportation challenges make telehealth a smart solution for many of them.
"Patients who had never utilized telehealth before realized, 'This is a way I can get what I need without having to deal with getting in a car, driving to hospital, a clinic, or a health care facility,'" Peters says. "With telehealth, they don't have to deal with all those logistical issues."
Peters notes that telehealth has bolstered behavioral health care, especially for people who fear the stigma associated with seeking treatment publicly at a mental health clinic. He also sees telehealth as a boon to those living in Michigan's rural communities.
"They can access a specialist's expertise using telehealth consults that don't necessarily need to be in person," Peters says. "There are people who can't afford and don't have readily accessible transportation. When we look at the transportation issue, this is a game-changer, and it really does help those patients have access."
Telehealth also has allowed Michigan's hospitals to expand their reach and increase revenue opportunities.
"Rewinding the clock, at one point in time, only those who lived a very short distance from the hospital would access services," Peters says. "Now, there are major tertiary or quaternary care hospitals drawing from a much larger geography."
Helping older adults with telehealth literacy
HFH is one of the Michigan hospitals on the frontlines of ensuring that everyone who wants to take advantage of telehealth feels confident and comfortable doing so. HFH operates 46 medical centers along with more than 250 locations throughout Michigan that include five acute care hospitals, two destination facilities for complex cancer and orthopedics and sports medicine care, three behavioral health facilities, primary care and urgent care centers. Many of its primary care providers, and providers in nearly every specialty
, utilize some form of virtual care, such as MyChart
messages or video visits. HFH's MyCare on Demand virtual urgent care service also offers video visits 24/7.
"Once you have the MyChart app, you have access to all of the abilities to not only send messages but to do MyCare on-demand virtual visits," Burgess says. "You can also get lab results and everything like that. It's the first step to having that access at your fingertips."
To improve patients' access to these services, White-Perkins is developing a curriculum that both educates providers on how to introduce telehealth to older adults and trains peer digital navigators as coaches to help other older adults realize the value of telehealth and teach them how to use it.
"We've worked closely with the Collaborative to get their feedback on what they thought the needs of older adults might be," White-Perkins says. "We also did some focus groups and a literature review to look at some best-practice examples of ways to improve the virtual care experience for older adults. All of that came together to form our core content."
Dr. Denise White-Perkins.
Next, White-Perkins engaged faculty at various medical residency programs to review the content and develop modules for training providers to do a better job of ensuring older adults have a positive telehealth experience. Currently, an instructional designer is developing the curriculum's final format, which will be piloted in early 2024.
"There's such a need to engage older adults," White-Perkins says. " We recognize that there's a responsibility for health care teams and health care providers to make sure older adults are engaged. This will be a very helpful resource for residency programs that are training the next generation of providers."
HFH's peer digital navigators will meet with other older adults to assess their digital literacy, introduce them to the technology, and connect them with HFH tech support to get them started. HFH staff's hope is to set up hubs throughout Detroit where the peer digital navigators and community members can meet.
"By having these trained older adults out in the community, we can help a variety of people," White-Perkins says. "The whole idea is to move outside of the four walls of our health system and engage people with services, especially helping older adults in the community to access this vital way of getting care."
Burgess is amazed by telemedicine's broad outreach. It gives patients who live further away, have mobility issues, or lack transportation a convenient way to receive care. It helps her to deliver care more efficiently. And it allows her to manage some patients' care without them having to come into the office for multiple visits.
Dr. Jennifer Burgess.
"It's interesting because when telehealth visits are back to back, you actually can stay on time better because you're not having to wait for the patient to be roomed or to get labs. It can help keep me on task and on schedule," Burgess says. "The efficiency actually is something I would not have expected."
Combined with other in-home opportunities like blood pressure and weight monitoring or in-home blood draws, telehealth overcomes many barriers to health care access that keep older adults and others from receiving needed care.
"When I started my career in health care almost 30 years ago, we spent a lot of time talking about transportation. We gave vouchers and bus passes, and we worried about how people were going to get to their appointment. Now, telehealth is the new way that people can get to their appointment and get the health information they need," White-Perkins says. "Telehealth is a wonderful resource. But we need to make sure that we are including everyone in terms of being able to access that resource and utilize its fullest potential."
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.
Brian Peters photo courtesy of Brian Peters. All other photos by Steve Koss.