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“[R]eimbursement and consumer interest are going to drive telemedicine. Patient experience should be the starting point.”
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Viewing Telemedicine Through a Safety Lens

By Sharon Quinlan | Thursday, May 26, 2022
Viewing Telemedicine Through a Safety Lens Photo by K8 | Unsplash

Patient safety experts, like Sharon Quinlan, DNP, MBA, RN, NEA-BC, System Vice President, Nursing Practice & Quality, Advocate Aurora Health, are thinking about the future of telemedicine. For example, Quinlan, co-chair of the expert panel that developed the framework supporting the Institute for Healthcare Improvement (IHI) Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care white paper, wonders whether widespread use of telemedicine will fade as responses to COVID-19 evolve.

“I’m concerned that people will revert to what’s familiar and most comfortable for them,” Quinlan noted. “For clinicians that might mean, ‘Hey, I’ve done office visits my entire clinical career, and there’s just a degree of difficulty and some glitchiness with telemedicine that I don’t want to put up with.’” Instead of looking at the COVID era as having great potential for transformational change, she fears that “clinical inertia” will constrain future telemedicine design and innovation.

“We can do some incredible process redesign using telemedicine,” Quinlan asserted, “because now geography doesn’t matter as much.” As an example, she describes a scenario in which patients can now have successive care team meetings in one setting. “I could talk to different clinicians on my care team who are in different places and get the benefits of that collective clinical intervention.” Noting that such approaches have benefits for both patients and clinicians, Quinlan added, “I hope we don’t forgo those opportunities because of the temptation to revert to the familiar.”

Starting With Patient Experience

Quinlan has been a longtime advocate for improving patient experience by enhancing the value of care for patients. “The revolution in telemedicine [we’ve seen during the pandemic] largely came from necessity and the loosening of reimbursement constraints,” she noted, “but the future will depend on the patient’s needs and wants in terms of their adoption of this technology.” According to Quinlan, “reimbursement and consumer interest are going to drive telemedicine. Patient experience should be the starting point.”

Because the rapid adoption of telemedicine happened during a crisis, Quinlan hopes health care can now take the time to learn from the last few years with patient-centeredness in mind. Quinlan advises gathering insights into consumers’ experience, needs, and preferences. Sources can include direct engagement with patients and families, consumer insights surveys, advisory councils, or community partners. Both qualitative and quantitative patient experience data and demographic data should ideally be stratified by race, ethnicity, language, etc.

“We also need to look closely at who does and does not take advantage of telemedicine and in which forms,” Quinlan noted. This includes determining if there are population-level patterns in choosing video versus phone or when deciding which services are most amenable to telemedicine. This also involves noting possible differences in use and access to telemedicine based on a range of factors, including race, ethnicity, language, income, geography, broadband access, and access to (and skill with) technology. “Using a health equity lens is critical,” Quinlan said.

Co-Design Is Key

Quinlan is an advocate for co-design in telemedicine. In addition to being patient-centered, “co-design means collaboration within health systems,” according to Quinlan, and can include clinicians and staff with expertise in safety, organizational learning, quality, research, and human factors. Using an improvement approach, as Quinlan recommends, means identifying key stakeholders and engaging patients, clinicians, and other care team members who use telemedicine so they can contribute to “evolving the next generation of telemedicine.”

As part of this co-design process, Quinlan recommends asking a series of questions: What are the safety failure modes in telemedicine? How can those failures be mitigated? How can organizational learning in health systems develop a clinician’s comfort and expertise in managing different types of telemedicine visits? How do we measure the quality of the outcomes of those visits? How can we improve quality with the use of this technology?

Quinlan believes health care needs more research to answer these and other questions. “We have all gone through this huge change of interacting with people through technology,” she noted. “I don't think we understand the impact on us as humans and as a country.”

According to Quinlan, using the elements of the IHI telemedicine framework (Figure 1), “if applied thoughtfully, could lead us to the future and fulfill the promise of telemedicine.”

IHI Framework for Ensuring Safe Equitable Person-Centered Telemedicin

Figure 1. Framework for Ensuring Safe, Equitable, Person-Centered Telemedicine

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What Are the Keys to Safe, Equitable, Person-Centered Telemedicine?

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