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The ability to access the Internet and use associated technology has been called a social determinant of health because of its broad impact across all domains of a person's life.1 The COVID-19 pandemic brought into sharp focus the extent of disparities in access to technology and the ways in which lack of access exacerbates disparities in education, employment, health and other domains.2–4 In health care, this is particularly relevant for use of remote tools such as telehealth to access care. Disparities in use of remote tools existed prior to the COVID-19 pandemic as demonstrated by racial, age and income differences in use of patient portals as well as tools specific to telehealth.5–7 In addition, despite the documented ability of telehealth to improve patient care while reducing barriers to access such as time away from work and travel time for patients,8–10 use of telehealth prior to the pandemic was not equal across the country.11,12 Before the rapid expansion of telehealth services during the COVID-19 pandemic, disparities in the types of health care organizations offering telehealth had been documented: underserved communities were less likely than others to be offered telehealth services.13
The shift to a virtual setting to protect both patients and clinicians from increased exposure to COVID-19 exacerbated barriers related to digital skills and access and highlighted the broad implications of the digital divide.7,11 Many patients who could previously access in-person care found themselves struggling to receive care in this new virtual setting. Those without a regular source of health care pre-COVID faced even greater challenges in accessing services including telehealth early on in the pandemic. As a result, the pandemic has caused us to redefine how we consider equity in access to technology and how we can bring about greater equity. Below, we re-examine the concept of five dimensions of access originally proposed by Penchansky and Thomas in 1981,14 and draw upon the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to suggest mechanisms through which health care organizations can increase equity in access to telehealth.15
The NIMHD Research Framework offers guidance in understanding and addressing health disparities by considering the intersection of a range of factors at the...