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"Telemedicine and its effects on patients, health care professionals, health organizations, and society have yet to be fully explored."
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Exploring More Than the Tip of the Telemedicine “Iceberg”

By IHI Multimedia Team | Wednesday, November 18, 2020
Exploring More Than the Tip of the Telemedicine Iceberg
Photo by Danting Zhu | Unsplash

Even before the COVID-19 pandemic, the use of telemedicine was called “a new era of medicine” and praised for its potential to reduce health care expenditures, improve quality and safety, and enhance self-empowerment for patients. Many people now use technology to see their doctors, get lab results, renew prescriptions, or book appointments. In Denmark, general practitioners offer video consultations via the Min Læge (“My Doctor”) app. Now that limiting physical contact where possible has become a priority, telemedicine has gained momentum around the world.

But what do we really know about the positive and negative effects digital services have on patient safety? For the past two years, the Danish Society for Patient Safety (PS!) has examined this question.

What We’ve Learned So Far

In collaboration with the Centre for Innovative Medical Technology (CIMT) and with support from HelseFonden (the Health Foundation), PS! carried out a major analysis of international and Danish experiences with telemedicine and its effects on patient safety. Based on what we’ve learned, there seems little doubt that health care providers will continue wide use of telemedicine beyond COVID-19, but we’re only seeing the tip of the iceberg when we consider its consequences for patients and health professionals.

A systematic literature review, in which data from 59 publications has been analyzed, shows that telemedicine can have both positive and negative effects on patient safety. These effects result from using technology that compels new ways to communicate and behave. Our analysis shows this can create hazards, but also benefits, for health care professionals, patients, and health care organizations.

Interviews with Danish health care professionals have indicated that, in some cases, telemedicine can support care that’s more timely, patient-centered, safe, and more in line with a patient’s needs and wishes. In other cases, telemedicine can jeopardize patient safety. It can, for instance, lead to communication errors between a health care professional and patient. Also, telemedicine was not designed for all types of assessment, so its inappropriate use can lead to delays in care and eventually patient harm.

5 Recommendations

Telemedicine and its effects on patients, health care professionals, health organizations, and society have yet to be fully explored. Even after extensive review, our overall conclusion is that we know relatively little about telemedicine’s effects on patient safety. Given its widespread use, there is an urgent need for further examination.

During our interviews with Danish health care professionals, each person highlighted the need to create a robust infrastructure that supports nationally driven work to identify adverse events when using digital health care. In other words, we need a systematic approach to assess telemedicine to get a clear picture of the circumstances that make telemedicine beneficial or harmful.

Based on the report’s findings, and our many years of patient safety experience, D! recommends the following for future evaluation of the digital health care system in Denmark:

  • Collect data on the effects of telemedicine on patient safety.
  • Create a more systematic method for development and implementation of telemedicine solutions.
  • Develop a more systematic focus on learning, including what goes wrong and what works well.
  • Focus on risk stratification of the user and technologies.
  • Help both patients and health care professionals learn to use telemedicine technology more effectively.

Based on our communications with other organizations, we believe these recommendations may also apply beyond Denmark.

Telemedicine "Explorers"

After learning of our findings, IHI Vice President Frank Federico commented, “Our colleagues and Strategic Partners at the Danish Society for Patient Safety have done a great service to health care worldwide with this report. Information such as this helps drive the efforts to more fully understand how to use telemedicine to provide safe care. We look forward to exploring more with them.”

We need other researchers and practitioners to help us discover more about the possibilities and pitfalls of telemedicine. We need explorers, like Roald Amundsen, who was credited with being the first to reach the South Pole, and Fridtjof Nansen, who led the first documented crossing of the Greenland interior, to join our expedition and push the boundaries of what’s known. We hope we all share what we learn along the way so we can continue to improve patient safety together.

Inge Kristensen is the Chief Executive Officer of the Danish Society for Patient Safety. Tatjana Sandreva, MD, is a project manager at the Danish Society for Patient Safety. Jens Reventlov is a senior advisor to the Danish Society for Patient Safety.

You may also be interested in:

Patient safety and telemedicine: How does telemedicine affect patient safety? International and Danish experiencesExecutive Summary in English and full report in Danish

Mind the gap; rapid implementation should also include a system to report and learn from errors

Tips You May Not Know to Improve Telehealth for Patients and Providers

How COVID-19 and Telehealth Have (and Haven’t) Changed What’s Next for Primary Care

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