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With Telemedicine On The Rise, Black Americans Risk Being Left Behind

A map generated by SAVI at IUPUI shows rates of internet access by race.

A map generated by SAVI at IUPUI shows rates of internet access by race. (SAVI at IUPUI)

After DorShann Lewis, a Black working mother in Fishers had her baby late last year, she relied on virtual visits to see her doctor. 

“It was much more convenient,” she says. “I didn’t have to deal with the mask and just the overall fear. And just having the flexibility to be at home and to know that I was safe at home with the kids.”

The COVID-19 pandemic has jump-started telemedicine — remote healthcare services that take place on a computer or phone.

But many Hoosiers who don’t have a computer, or who lack stable internet access at home, risk being left behind. And new research shows that Black communities are the most likely to lack complete access to telemedicine services.

Data analysis by the research group SAVI at Indiana University Purdue University Indianapolis shows that 28% of Black Hoosiers do not have a computer or reliable internet service at home. 

Analyst Unai Miguel Andres says the disparity is so big that we should pause and think.

“It is important to understand who is benefiting from these services and who is not,” he says. “And I think looking at this access to a computer, internet … or both can provide a really good lens on who might be left out.”

At the MLK Center, executive director Allison Luthe sees the impact of this connectivity gap. “Even recently, with all of the rental and utility assistance that's available, the emergency assistance and even unemployment assistance, you have to be able to do that online.”

But it is not just that. Since the pandemic started, telemedicine services have increased 154% across the U.S. according to the CDC. And Indiana is no exception.

“So if you look at last year's numbers, we were lucky to complete about 20 visits a day … and now we complete almost 2,000 visits a day,” says Dr. Michele Saysana, chief medical officer for virtual care at IU Health.

She says a lot of these services can be handled over the phone. But as institutions develop new virtual health options to enhance the quality of care, not having access to the internet could mean that Black Americans will be missing out. 

Dr. Patrick McGill, executive vice president and chief analytics officer of Community Health Network, agrees. 

“We do see the disparities between race as it comes to access with reliable telephone and internet access,” he says. “Some of our minority patients preferred telephone versus video. And so whether that's related to comfort, whether that was related to usability of the system, whether that was related to reliable internet access versus telephone access, we haven't been able to tease those out.”

Community Health Network aims to address this disparity. Like other providers, it asks patients about a range of factors that can influence health, including access to reliable housing, food and transportation. McGill says it is adding two new questions: "Do you have access to reliable telephone service? Do you have access to reliable internet?"

But why does this disparity in internet access — seen in rural areas as well as cities — exist in the first place? 

“Rural communities tend to lack adequate access to the technology,” says Roberto Gallardo, director of Purdue University’s Center for Regional Development. In urban areas, it tends to be an issue of affordability.

He says many families can’t afford a home internet subscription as well as a cellular phone data plan. Given that choice, they opt for the phone plan. 

To bridge this gap, Gallardo says the first thing needed is reliable data. 

“It's very hard to get accurate, granular data,” he says. “The federal data set is the closest we have but it is known to overestimate coverage or access. Another big, big dark area that exists is that there is no cost data. We don't know how much is being charged in certain areas, and for what technologies.” 

The federal government included $7 billion in the second stimulus package to improve internet access. Some internet providers have also offered assistance programs for low-income families during the pandemic. 

Luthe of the MLK Center says these programs are a step in the right direction, but are not always as helpful as they sound.

“Even the ones that came out and let folks have a free Wi-Fi hotspot, you had to have no outstanding balance,” she says. “So for some folks, they had an old bill, or a previous bill at a previous address that had to be cleared up before they could get internet access.”

She says, it is like a vicious cycle — with one hurdle leading to another.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

For the latest news and resources about COVID-19, bookmark our Coronavirus In Indiana page  here. 

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