Telehealth is here to stay. Three leaders talk about quality and safety of virtual visits

With the coronavirus pandemic, telehealth has­ become the default venue for a wide variety of clinical visits. As this shift is expected to continue beyond the pandemic, we asked three health care leaders:

What do we know about the efficacy of telehealth
and its impact on quality and safety?
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Joseph C. Kvedar, M.D.

Joseph C. Kvedar, M.D.
Professor, Harvard Medical School
Senior Advisor, Virtual Care, Partners HealthCare
President-Elect, American Telemedicine Association

One way to approach that question is to ask, “How is telehealth different?” Before the public health emergency, we saw a limited number of complaints, things like sinus pain, conjunctivitis and sore throat. Measuring quality for those televisits is similar for office visits. We can ask, “Did I solve the patient’s problem to their satisfaction?” “Did I prescribe medications according to guidelines?”

Fortunately, telehealth is well suited for COVID-19 screening, which largely amounts to asking a set of questions. If the patient seems to have the virus and is well enough to quarantine at home, we monitor them with another set of questions. Quality measures might include, “How often did you reach out to the patient?” and “Did you ask if they have sufficient support at home?”

With non-COVID patients, I think it’s appropriate to say we're doing our best. To advise clinicians doing televisits for the first time, I say, “You have to know what you need to make a diagnostic or therapeutic decision. If you can get that without touching the patient, you can probably do this.”

The simplest answer to your question is, if we are thoughtful about the indications for using telehealth, quality is likely to be very high. If we stray into areas where a physical exam is needed — where I have to touch you or use an instrument to get the information I need to make the diagnosis – and we don't do that, then quality will suffer.

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Barbra Rabson, M.P.H.

Barbra Rabson, M.P.H.
President and CEO, Massachusetts Health Quality Partners

Crises have a way of opening new opportunities and presenting innovative solutions that were barely conceivable before. Many people in healthcare have long advocated for telehealth as a way to improve access but have not been successful promoting its widespread adoption. Our healthcare system has moved tens of thousands of patients to new telehealth programs virtually overnight to allow patients to be seen during the COVID pandemic. We now have an enormous opportunity and responsibility to come out of the pandemic with as much insight as possible to make healthcare more patient-centered by leveraging telehealth.

As we transition from emergency fix to ongoing practice, perhaps the most important metrics of our success should be patient and provider experience. We need to gather data about what’s working well and how to best improve what’s not working well. We can do this by listening hard to feedback about how this is working for patients and providers, and then using this data to inform policy and ongoing efforts to improve the telehealth experience.

Toward that end, MHQP has been interviewing patients and providers about their experiences with telehealth — and we are learning a lot. Importantly, we are finding that telehealth seems to work better than in-person visits in some cases. We need to learn more. It is incumbent upon all of us to optimize telehealth’s application to help shape a safe, patient-centered future for healthcare.

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Frank Federico, R.Ph.

Frank Federico, R.Ph.
Vice President, Senior Patient Safety Expert, Institute for Healthcare Improvement

As with face to face visits, the quality of telehealth needs to be informed by metrics.

For example, we must examine safety by measuring morbidity and mortality of patients who receive care in this manner. Diagnostic errors must also be considered. Overuse, which may result from ease of use of technology and reimbursement structures, is another consideration.

Access — the patient’s ability to participate and schedule visits — will be important as inequities can result from lack of internet connections, computers and limited English proficiency.

Patient and family experience must also be considered. Co-design of telehealth encounters will be helpful in ensuring the visit is positive for patients, as well as for clinical staff. When patients are seen in the office, for example, clinicians are encouraged to ask the patient about their goals for the visit. They should do the same for televisits.

Patient-reported outcomes — patient’s health, quality of life or functional status associated with health care or treatment — will also inform us as to how telehealth is impacting the quality of care delivered. And clinician and staff satisfaction must also be measured and monitored.

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Email us your feedback and comments: patientsafetybeat@state.ma.us