Using Telehealth as a Tool to Improve Equity

The Lown Institute unveiled its ranking of America’s most racially inclusive hospitals this week, and Boston Medical Center secured the top spot on the list.

Boston Medical Center uses telehealth and remote patient monitoring to track pregnant patients who are at risk for complications. (Photo: Boston Medical Center)

The think tank examined more than 3,000 hospitals and the racial and ethnic demographics of the patients they serve. In announcing the awards, the Lown Institute held an online discussion about improving health equity in disadvantaged communities.

Elena Mendez-Escobar, co-director and executive director of strategy at Boston Medical Center’s Health Equity Accelerator, pointed to the importance of making it easier for patients to get the care they need.

As hospitals look to find ways to make healthcare more accessible to patients, she said telehealth and remote patient monitoring can be part of the solution.

“It’s about providing care in a way that is more convenient or even possible for our patients,” Mendez-Escobar said.

Boston Medical Center has been using remote patient monitoring to help keep tabs on pregnant patients to help them avoid more serious complications.

The hospital has found that some of their Black patients develop complications tied to preeclampsia, and 18% of the medical center’s Black patients develop high blood pressure during their pregnancy, Mendez-Escobar said. “That’s a very high number,” she said.

While one option would involve having patients visit their doctor once or twice a week for checkups, that’s not always feasible.

“That's not possible for a lot of people,” Mendez-Escobar said. “That may require taking half a day off work. They may not be able to do that. They may require childcare to do that.”

Instead, Boston Medical Center is providing patients with remote blood pressure cuffs so they can do checks at home, and the devices transmit the information to their doctor’s office. The patients “don’t have to do anything. They don’t have to text it,” Mendez-Escobar said.

The hospital also provides information to patients about warning signs, including when they should go to the emergency department.

“That has really accelerated how quickly we can diagnose preeclampsia and how quickly we can treat it because we're building real agency in the patients,” she said.

Mendez-Escobar said she hates to describe such care as convenient “because it makes it sound less important.”

But she says it’s important for Boston Medical Center, and hospitals around the country, to find ways to offer care that fits in with their patients' lives, their jobs and their childcare situation.

Hospitals and health systems still need to be accountable in providing high quality care, but they need to do it “in different ways that really make it possible for the patient to be accessing that care,” Mendez-Escobar said.

Boston Medical Center outlined some results of its remote patient monitoring in a study published in Circulation, the journal of the American Heart Association. Researchers found that 98% of patients used the remote blood pressure monitoring, and the participation rate was high across racial and ethnic groups.

As health systems are looking to provide more care outside the hospital, Mendez-Escobar notes that options can’t be limited to outpatient facilities in the suburbs that aren’t easily accessible to patients with lower incomes.

“It’s not only transitioning into some other institution, but sometimes it may mean using more telemedicine,” she said.