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Recommendations for Designing High-Quality Telehealth

Why It Matters

As the use of telehealth rapidly expands, it's important to ensure quality care is part of its design.
Recommendations for Designing High-Quality Telehealth

Before the COVID-19 pandemic, telehealth was a hot topic when discussing the future of health care. Its use, however, was far from widespread and used primarily in certain specialties

Now, with physical distancing and stay-at-home orders in place because of the coronavirus, telehealth has become a necessity for many. In addition, the Centers for Medicare and Medicaid Services (CMS) issued an emergency response, lifting a major barrier to its widespread use by broadening access to telehealth covered by Medicare. All this has accelerated the adoption of this modality of care in the US.

But is telehealth here to stay? Will providers find that telehealth is an effective method for providing care? Will patients prefer the option of televisits over traditional face-to-face appointments? After the COVID-19 pandemic ends, will CMS return to limiting telehealth access? And who is addressing the safety and quality of this approach to delivering care?

There is much we do not know about the future of telehealth, but as its use rapidly expands and we prepare for the future, we can all agree that telehealth must be safe, effective, efficient, timely, equitable, and patient-centered. As many health care providers are now developing, deploying, and delivering telehealth, we invite you to consider the following recommendations put forth by the IHI Innovation Team for designing high-quality virtual care systems:

Design and Implementation

  • Engage Patient Safety Officers who can help incorporate quality and safety considerations into plans for design, implementation, and operation of telemedicine systems.
  • Work with clinicians to clearly define what conditions can be safely managed virtually.
  • Institute central governance over telemedicine so that one person or team (instead of multiple separate service lines) can help ensure consistency and the involvement of the quality department.
  • Walk through where things could go wrong and potential unintended consequences during design and set up.
  • Standardize the tech platform to support all telemedicine services within a health system. Use a checklist that includes quality and safety considerations when making purchasing decisions. Integrate clinical workflows into the platform.

Clinician Support

  • Use a systematic approach to developing protocols for virtual care. Reduce variation between specialties and service lines by training providers to provide a standardized high-quality care experience for patients.
  • Determine standards for which symptoms and conditions can be managed virtually. Use these standards to triage patients who request a virtual visit.
  • Give clinicians real-time access to patient data.
  • Be aware of regulations around scope of practice because limitations regarding what different health care disciplines are allowed to do vary by state.
  • When relying on remote consultations for inpatient care, mandate that another clinician should be at the patient’s bedside to assist during the session.

Patient Engagement

  • Ensure representation of the patient perspective by involving them in the co-design of your telehealth services.
  • Encourage patients to invite a friend or family member to join televisits to help take notes or remember what was discussed.
  • Provide patients with a checklist to prepare for the appointment.
  • Issue a standard quality, safety, and patient satisfaction survey post-visit.

IHI will apply practical improvement science to the growing field of telehealth and share what we are learning. 

Allison F. Perry is an IHI Director.

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