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Digital disparities: designing telemedicine systems with a health equity aim
  1. Margaret Samuels-Kalow,
  2. Todd Jaffe,
  3. Kori Zachrison
  1. Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Margaret Samuels-Kalow, Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; msamuels-kalow{at}


The use of telemedicine has grown immensely during the COVID-19 pandemic. Telemedicine provides a means to deliver clinical care while limiting patient and provider exposure to the COVID-19. As such, telemedicine is finding applications in a variety of clinical environments including primary care and the acute care setting and the array of patient populations who use telemedicine continues to grow. Yet as telehealth becomes ubiquitous, it is critical to consider its potential to exacerbate disparities in care. Challenges accessing technology and digital literacy, for example, disproportionately impact older patients and those living in poverty. When implemented with the consideration of health disparities, telemedicine provides an opportunity to address these inequities. This manuscript explores potential mechanisms by which telemedicine may play a role in exacerbating or ameliorating disparities in care. We further describe a framework and suggested strategies with which to implement telemedicine systems to improve health equity.

  • access to care
  • COVID-19
  • emergency care systems

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  • Handling editor Simon Carley

  • Twitter @m_e_s_k

  • Contributors MS-K and KZ conceptualised the paper; MS-K and TJ wrote the original manuscript. KZ revised the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.