Addressing Public Health Needs With Health Technologies During COVID-19: A Medical Student Perspective

The challenges posed by the COVID-19 pandemic were met with rapid scaling up of health technologies, which has affected health care access in public health settings. We highlight the benefits of technology in addressing social determinants of health and discuss its limitations for communities at risk for health disparities. Additionally, we consider Penn State Project ECHO (Extension for Community Healthcare Outcomes) as an interdisciplinary tool to meet clinical and community health needs. We end by examining how the pandemic has molded the current and next generations of medical students.

Early in the pandemic, the need to avoid physical, in-person contact to contain the spread of COVID-19 created a new standard of health care delivery. A recent study observed a reduction of office-based visits by 1520.8 visits per 10 000 people from April 2019 to April 2020.¹ Emergency department visits also decreased by 42%, comparing March 29 through April 25, 2020 to 2019.² Although in-person visits were decreasing, telemedicine, the use of telecommunication to remotely diagnose and treat patients, rapidly escalated by 4081% from April 2019 to April 2020.¹ Before COVID-19, telehealth services, which broadly encompasses telemedicine and tele-education, faced barriers to widespread implementation. The pandemic created the perfect storm for rapid telehealth integration, allowing providers to treat patients more conveniently and safely in the patients’ homes.

Telehealth can also serve as an innovative intervention to address key social determinants of health, including health care access, socioeconomic conditions, and transportation. In 2018, a quarter of rural Americans reported traveling an average of 34 minutes to the closest acute care facility, 15 minutes longer than their urban counterparts.³ Rural barriers are compounded by a lack of public transportation and personal vehicles. This situation is further exacerbated by hospital closures, including 21 in 2020, abruptly suspending outpatient, inpatient, and emergency services to its respective populations.⁴ Telehealth can increase hospital geographic catchment, in turn combatting barriers to health services, especially in rural settings.

An increased reliance on technology, however, may perpetuate gaps in care among populations at risk for health disparities and limited health care access. In 2018, only three quarters of US adults had broadband Internet services at home.⁵ Those who were the least likely to have these services included racial/ethnic minorities, older adults, rural residents, and those with lower levels of education and income.⁵ This year, the highest utilization of telemedicine was among White (≥ 80%) populations and those in zip codes with populations living at greater than 400% of the federal poverty line.¹ This suggests that telemedicine has less opportunity for impact among our most underserved populations, demonstrating the challenge of using technology to improve equity without systemic solutions.

The urgency for virtual care has opened the floodgates for the rapid implementation of other health technologies. Bluetooth-enabled apps that automate contact tracing have set a precedent for surveillance tracking and outbreak response. Technology for the distribution of COVID-19 vaccines has been imperative for dose tracking, monitoring adverse events, and delivering information to the public. Other areas have also expanded, such as artificial intelligence for cough analysis and radiology findings, e-triaging tools integrated into emergency department electronic health records to decrease transmission risk and predict patient outcomes and readmissions, and products to monitor vitals for populations vulnerable to COVID-19. Understanding the boundless opportunities of health technology during the pandemic has exposed the next generation of physicians to innovative solutions to public health needs.

Using existing technology infrastructures during COVID-19 has been an efficient way to promote care collaboration with a reliance on virtual interdisciplinary teams. For example, Project ECHO is a global telementoring initiative that brings health care providers and subject matter experts together via video conference technology.⁶ During COVID-19, Project ECHO has united physicians, nurses, social workers, pharmacists, researchers, and educators across the country to disseminate information on evidence-based practices for COVID-19 management, telehealth training, and vaccine safety and education. These educational efforts widened expertise on a variety of COVID-19 topics, increasing the knowledge, confidence, and competencies of all providers and enabling the collaboration of various disciplines for patient care.

Another opportunity for interdisciplinary team-based care and education is to assist in addressing the COVID-19 pandemic’s disproportionate impact on racial/ethnic minority communities in the United States.⁷ For example, Project ECHO partnered with Better Together REACH (Racial and Ethnic Approaches to Community Health) in March 2020 to conduct community-facing webinars in Spanish.⁶ The goal was to educate the local Hispanic population about COVID-19, empowering community members to actively engage and ask questions in their native language. In this way, Project ECHO can provide education directly to communities at increased risk for health disparities and to providers who serve them. With ECHO “hubs” spanning the globe, Project ECHO offers institutions and academic centers the opportunity to improve care delivery and medical students to gain experience in clinical case-based learning and community health programs.

As first-year medical students during the onset of COVID-19, my cohort was in a unique position to view the health system with fresh eyes and begin to develop the skillsets that would prepare us for the changing landscape of health care. Immediately, all educational lessons, including physiology lectures, anatomy lab sessions, and clinical skills sessions, were moved to a virtual platform, creating a more flexible and personalized educational experience. Virtual clinical sessions with reduced physical exam capabilities were a stark contrast with traditional hands-on learning. Although initially challenging, this experience augmented the communication skills necessary to conduct effective virtual visits earlier than would be expected, preparing us for the increasing number of telehealth visits during rotations and residency. As future physicians, we must recognize not only telehealth’s many benefits but also its limitations, especially in regard to populations with health disparities, and identify the conditions and situations for which telehealth will be beneficial. With deeper knowledge about health technologies, we will also be more equipped to overcome barriers to care for our patient populations.

Furthermore, the pandemic offered an opportunity for my cohort to address critical community and hospital needs in real time with out-of-the-box thinking, catalyzing a more macrolevel and hands-on understanding of health care. Our Penn State Health student body promptly assembled interdisciplinary COVID-19 task forces, focusing on topics such as contact tracing, technological advancements, clinical engineering and supply chain, and community health education. The quicker integration of emerging protocols, initiatives, and technologies at health institutions allowed students to make considerable contributions. Future generations of medical students would undoubtably benefit from curricula that use COVID-19 as a case study to explore the interdependency of public health and clinical medicine, technology use to address social determinants of health, and other aspects of public health, such as epidemiology and community health education.

COVID-19 was an impetus for the almost overnight shift in reliance on health technologies, and it has transformed public health. Although the pandemic created a great deal of uncertainty for medical students, it irrefutably shaped our generation and lent us a more robust educational experience with unparalleled opportunities to gain skills and knowledge of the health care system from a multidisciplinary approach. As we step into our roles as future physicians, we will be better equipped to address public health needs with existing or unconventional technologies. It is, however, imperative for us to ensure that current and future technology allows equitable and equal access to care for all Americans, including populations with significant health disparities.