Table 3.

Synthesis of recommendations from select literature on virtual care and health equity during the COVID-19 pandemic.

Level of initiative to enhance health equity in virtual care and general recommendations		Specific recommendations
Policy and government
	Government policy	Government policy should clarify standards for inclusive design of digital health innovations Governments should increase access to relevant crisis and social services in support of marginalized communities (eg, social support phone lines) Governments should invest in maintaining expanded virtual care programs beyond the end of the pandemic
	Funder (reimbursement)	Identify reimbursement models with insurers for marginalized patients that can persist beyond the end of the pandemic Ensure payment parity between insurers for video and audio visits
	Access to devices and internet	Identify and document disparities in access to virtual care Promote access to broadband internet, especially among those who cannot afford it Promote access to digital devices among those cannot afford them (eg, through donations and lending programs at health care sites) Explore quality improvements related directly to existing disparities in access to digital devices
	Public health messaging	Increase emphasis on and diffusion of culturally relevant public health messages (eg, increase redundancy of important messaging) Increase control over quality, understandability, and acceptability of messaging about transmission, prevention, treatment, and consequences of COVID-19
Organization and health system
	Organizational (health system or health care organization)	Measurement of equity-related outcomes such as number of visits using interpreter services Quality improvement focused on equity-related outcomes Train health providers to have competencies to provide equitable digital health care Increase virtual access and use of interpretation services for health care encounters Translate instructions for accessing virtual care Increase system leadership awareness of equity-related barriers to virtual care Offer telemedicine outside of usual business hours Promote virtual care widely to grow awareness among marginalized communities Adopting organizations should include equity considerations in newly established digital services Engage community health workers to provide technical support to patients with low digital literacy Provide interfaces in languages other than English Develop programs to lend digital devices to patients who do not have access to such devices during the course of care Provide access through a variety of programs, not solely through the electronic record system
	Clinical	Select phone over video for individuals who are not comfortable with video visits in the home environment Offer digital services to all patients Combine technology and in-person visits, enabling care for people without access to technology Advocate changes to support equitable access to virtual services at the local level Provide training and support to patients seeking to access care virtually Build processes for assessing patient readiness for virtual care Conduct test visits with patients for troubleshooting prior to scheduled virtual clinical visits
Community and patient
	Community engagement in service planning and delivery	Partner with community organizations to provide peer-led educational support Involvement of people from marginalized groups in leadership, health professions, co-design, and data stewardship Vendors should use inclusive, user-centered design processes
	Enhance digital literacy	Develop programs to promote digital health literacy Mitigate digital literacy and resource barriers (eg, provide patient education to enhance digital literacy skills, inform patients about free or reduced-cost internet access locations)