The COVID-19 pandemic accelerated a transition to telemedicine that had been slowly underway for years. Defined as the diagnosis and treatment of patients through telecommunications technology, telemedicine holds great promise. It is important, however, to be mindful of the key principles of quality and the unique risks, opportunities, and potential unintended consequences of virtual care. Whatever role telemedicine may play in the future, health systems and providers need guidance to successfully implement safe, high-quality telemedicine services. Toward that end, the Institute for Healthcare Improvement (IHI) has published a white paper, Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care. The following is an adapted excerpt from the white paper.
In the evolving field of telemedicine, health care providers and systems have paid attention to issues such as technology and reimbursement. But there has been less focus on ensuring that telemedicine can meet the same goals for quality as in-person care. What might be the distinctive safety concerns and unintended consequences of telemedicine? With the rapid uptake of virtual care during the pandemic, it is more important than ever to apply improvement science to ensure that telemedicine embodies quality — that it is safe, effective, efficient, timely, person-centered, and equitable.
In 2020, the Institute for Healthcare Improvement (IHI) Lucian Leape Institute convened a virtual meeting of experts from around the world to develop a framework for ensuring safe, equitable, person-centered telemedicine, focusing on three aspects of quality. The expert panel’s preliminary research found that safety, equity, and person-centeredness are often afterthoughts in the design and implementation of telemedicine services. Thus, the aim of the expert panel was to help address perceived gaps in existing research in these three areas by providing recommendations for high-quality virtual care. While the panel focused specifically on three of the six aspects of quality, it is critical to consider all aspects in the expansion of telemedicine.
Two key insights emerged from the expert meeting:
Health systems must avoid simply implementing telemedicine technology on top of current systems and instead reimagine the entire system, fully integrating telemedicine to ensure that it is safe, free from inequities, and truly responsive to the needs of patients, families, and the health care workforce; and
Health systems and providers must co-design telemedicine services with patients, families, and other stakeholders from the outset to ensure that they work for all.
A Framework for Ensuring Safe, Equitable, Person-Centered Telemedicine
The culmination of the IHI-convened expert panel discussions is a framework for ensuring safe, equitable, person-centered telemedicine (see Figure 1) that includes six elements:
During the expert panel discussion, these six elements emerged as risks and opportunities associated with providing safe, equitable, and person-centered telemedicine.
Figure 1. Framework for Ensuring Safe, Equitable, Person-Centered Telemedicine
While the framework and related recommendations in the Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care white paper specifically focus on telemedicine, this approach could be applied to address telehealth more broadly across the care continuum. Integrating telemedicine services presents an opportunity to rethink and redesign existing care processes and services — to ensure care delivery via the most appropriate mechanisms, provide better access, and reach more people while also improving value and quality.
Each health care organization needs to consider its unique context when developing a plan to implement the framework. A critical early step is to identify the technological infrastructure and other resources available to both the organization and the population it serves, including determining which services can be provided safely and with high quality using telemedicine and which services cannot. Organizations may use the Model for Improvement and iterative Plan Do-Study-Act (PDSA) cycles to guide their work by setting an aim, establishing measures, and testing and refining changes to improve telemedicine services to ensure that they are safe, equitable, and person-centered.
It is important to note that while some framework elements are mutually reinforcing, there is also the potential for elements to conflict (e.g., recording a telemedicine interaction with a patient can help clarify communication, but may undermine privacy). The guiding principle throughout is to honor the patient’s wishes as long as those desires are consistent with delivering safe and effective care.
To learn more about the Framework for Ensuring Safe, Equitable, Person-Centered Telemedicine, download the free white paper.
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