The COVID-19 pandemic has brought many unforeseen challenges to our nation. Yet, like many novel circumstances in the past, it has also served as a catalyst for new solutions — notably the widespread use of telehealth visits across America. While uptake in this method of care is likely to continue, we must not miss the chance to measure telehealth’s effectiveness in achieving high quality, equitable, person-centered care.
The pandemic has provided an opportunity to build uniform guidance for what a standard telehealth visit should look like, and how it should be documented and evaluated for quality. I believe that we are ready for this to happen, and I am excited to help clinicians ensure telehealth provides the same quality of treatment as an in-person visit.
As a physician and the CEO of the National Quality Forum, I’ve had the privilege to be involved in countless discussions with patients, clinicians, researchers and health care leaders from across our country about telehealth as a viable substitute for in-person care over the years. This is why, during the height of the pandemic, I saw it as my duty to serve as a virtual care provider when our health care systems were overwhelmed. This experience helped me gain first-hand appreciation for what the telehealth experience can offer. Telehealth offers a remarkable view into our patients’ lives and homes, even more valuable given our understanding of social determinants of health, i.e. the impact of the environment in which people are born, live, work, play and age.
On a recent telehealth call, one of my patients was complaining of persistent and debilitating pain in her left shoulder. As we talked, I saw that she was the mother of a toddler who had come into the video call and wanted to be held. The way my patient lifted her daughter made it clear that this was the source of her shoulder issue, especially as her child was getting bigger and heavier. Seeing my patient’s life more fully than I would during an in-person visit gave me an insight that I could then provide guidance and treatment around. This is the kind of advantage telehealth can and should provide.
While the benefits of telemedicine are becoming clearer, many gaps still exist in telehealth oversight, regulation and standardization. The pandemic has provided an opportunity for NQF to reflect on our 2017 report, Creating a Framework to Support Measure Development for Telehealth, which provides a framework to develop and advance quality measurement for telehealth. Then, like now, our goals for telehealth remain the same: We do not have to sacrifice quality outcomes to increase access. We can embrace this practice while balancing with the need for measures of access to care, financial impact and cost, experience, and effectiveness.
We would like to see telemedicine become more accessible to patients, but in order to not sacrifice quality, we are calling for telehealth to be evaluated in six key areas: travel, timeliness of care, actionable information, added value of telehealth to provide evidence-based best practices, patient empowerment and care coordination. These measures still have the potential to assess whether telehealth is comparable to, or an improvement over, in-person care, as well as demonstrate if telemedicine has a positive effect on quality health outcomes, processes and costs. As the use of telehealth increases, without a standard, uniform definition for measures, it will be difficult to synthesize findings and assess its impact.
Only through measuring impact can we begin to ensure that the expansion of telemedicine objectively reaches promised goals, includes patient and safety improvements, reduces inappropriate care and leads to better health outcomes all while minimizing administrative burden.
Throughout the pandemic, telehealth is what allowed the health care system to rise to the occasion by overcoming geographical distance, enhancing access to care and building efficiencies. As we look to the future, we must ensure that telemedicine assists in normalizing high-quality care so that every person – especially the most vulnerable – knows their care will be safe, appropriate and person-centered regardless of modality.
Dr. Shantanu Agrawal is the president and CEO of The National Quality Forum, a not-for-profit, membership-based organization that gives all health care stakeholders a voice in advancing quality measures and improvement strategies that lead to better outcomes and greater value.
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