Has Telehealth Use During COVID-19 Disenfranchised Patients With Limited English Proficiency?

Nurse using a laptop computer, telehealth, telemedicine
Physicians aimed to increase quality of virtual care for patients with limited English proficiency during the COVID-19 pandemic.

Three strategies for addressing the efficacy of telehealth among individuals with limited English proficiency (LEP) were discussed in an article published in the “Trends from the Field” section in the American Journal of Managed Care.

Between October 2019 and September 2020, the interpreter services at Massachusetts General Hospital in Boston provided 127,018 interpretations in 127 languages. The most common languages were Spanish, Portuguese, Arabic, Chinese, and Haitian Creole. After March 2020, most ambulatory care was delivered virtually, during which time demand for interpretation services by telephone increased by 57%.

To address the gap in care among patients with LEP during the COVID-19 pandemic, the article authors highlighted 3 main areas which need to be addressed and actions they took or are planning to take to improve the patient experience.

Strategy 1 was to increase access to technologies for patients with LEP. In general, patients with LEP have lower baseline digital and health literacy. To combat this, access will be made easier by making the patient access portal available in the top 5 languages.

In a pilot project, bilingual staff contacted patients to inform them about the patient portal and invited them to register. Patients were provided with help guides or videos in other languages to instruct them on how to use the telehealth system. As of August 19, 2021, non-English educational materials had been viewed 3388 times, indicating there was sufficient demand for such materials.

Strategy 2 was to address privacy concerns. Some individuals with LEP may be worried that their information could be shared with Immigration and Customs Enforcement, causing them to avoid engaging in virtual care. This was addressed by distributing information about Health Insurance Portability and Accountability Act (HIPPA) rules in multiple languages and ensuring clinicians were sufficiently educated on HIPPA policies.

Strategy 3 was to ensure access to interpreters. There was a need to allow for integration between phone and computer without requiring additional software that could allow more than 2 people (patient, clinician, and interpreter) to deliver virtual care. The application Doximity was selected, as it is a HIPAA-compliant browser-based video system.

“[A]lthough virtual platforms allowed many patients to safely access care during the worst of the COVID-19 pandemic, they unintentionally disenfranchised a large segment of the population, especially those with LEP,” the study authors noted. “Although many health systems had to go live with virtual care platforms that were not intended for such rapid scaling, going forward we must commit ourselves to be more intentional with our design and implementation of virtual care so that we may truly meet the mission of providing quality care for everyone.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Tan-McGrory A, Schwamm LH, Kirwan C, Betancourt JR, Barreto EA. Addressing virtual care disparities for patients with limited English proficiency. Am J Manag Care. Published online January 14, 2022. doi:10.37765/ajmc.2022.88814