Defining Telehealth Quality Standards During the Pandemic

Telehealth has transformed during COVID-19. Although it once was a nice-to-have option not available at most doctors’ offices, the virtual conferencing technology has become indispensable for patients avoiding an infection risk. Now, telehealth and virtual services are available at most practices in America.

Many patients and providers are happy with this setup, indicating that it may continue beyond the pandemic. Based on demand, we’re seeing a shift from tele-urgent care to telehealth used for managing chronic illnesses. While telehealth looks like it’s here to stay, medical developers and experts are cautioning healthcare providers and telehealth platforms alike to analyze and improve the quality of this paradigm.

Meeting Demand While Maintaining Quality

Patient outcomes are impacted by healthcare quality. Since telehealth is growing in popularity at unprecedented levels, it’s unclear whether in-person measurements of quality translate to telemedicine. After all, a doctor who delivers amazing care in person may not be the best virtual doctor due to lacking technology experience and slow or unstable Internet connections.

As telehealth expands, we must adopt quality measurements related to equity, accessibility, and transparency. For example, telemedicine cannot be equitable when patients have limited access to smartphone technology or Wi-Fi. Telehealth platforms may not be accessible for patients who have low digital literacy. And for patients with hearing and vision impairments, telehealth is neither accessible nor equitable.

At the University of California San Francisco primary care clinics, there was an increase of more than 4,000% in the utilization of virtual services. But when researchers dived deeper, they found out that many patients who visited the clinic in-person before the pandemic were not accessing medical care through telemedicine avenues. These patients mostly fell into non-English speaking, elderly, and Medicaid groups.

Reviewing multiple published studies and research shows that telemedicine quality is not yet being evaluated rigorously or in a standardized manner. Other than the three measurements we just listed, there should be other measures of quality for telehealth providers and platforms, like unplanned ER visits, diagnostic accuracy, no-show data, patient satisfaction, medication adherence, and successful patient outcomes. The National Quality Forum Telehealth Framework and American Telemedicine Association are working on developing telehealth guidelines, but things aren’t moving fast enough to meet the demand and expansion of telemedicine technology.

Transparency for Patients

Patients already lack access to quality metrics about their provider. They usually use web-based reviews to find a physician, which have been shown to be faulty indicators of quality. And it often doesn’t matter what the patient finds in their web search as most highly-rated physicians and medical groups are booked up for months from now. Sometimes, the highly-praised provider doesn’t have availability until a year from now.

To help chip away at the problem, several companies are developing algorithms that predict quality based on historical data. An algorithm developed by Grand Rounds Inc., for instance, analyzes a provider’s quality based on measurements specific to their specialty. As an example, primary care physicians are evaluated by the algorithm according to their specialty referrals, patterns of prescribing pain medication, preventative screenings and check-ups, and skill in developing a long-term relationship with their patients.

These measurements were independently validated by Harvard researchers as helping to effectively predict the quality of the provider. But the patient, i.e. the party who needs this information the most, doesn’t get access to this information when performing a web search. We can change that with the implementation of quality measurements for telehealth providers by prioritizing transparency for patients. If we can shift the data that we allow patients to access, we can greatly improve equity and accessibility to quality care.

What We Can Do

The first step we need to take immediately is to standardize quality measurements. Because telehealth is here to stay, it’s imperative that we address this topic urgently as in-person care is going to remain impacted by the pandemic and throughout vaccination roll-outs.

After we identify the main quality metrics, we need to ensure that the data is easily accessible and available to patients, providers, and health systems. As we move through this process, the goal should become helping consumers vet and choose a telehealth provider while giving providers feedback for continuous improvement of medical practice and processes.

In addition to transparency, equity and accessibility should be prioritized. Practices should run analyses of their pre-pandemic in-person patients’ demographics as well as of telehealth patients’ demographics. These two analyses should be compared for any obvious changes in patient income, living situation, and race.

Providers should ask many questions, chief among them: “Are there certain populations not using telehealth?”, “What assistance can be given to patients in these groups to improve accessibility and usability?”, and “Who would benefit from using telehealth more often?”

Now is the time for a team effort from a multitude of organizations like academia, telehealth platforms, federal agencies, and healthcare systems to develop a set of measurable goals and metrics that can be used as telehealth continues to grow. Clinical societies, like the American Medical Association, should create guidelines for best practices for telemedicine by specialty. And medical schools should be training future doctors that are comfortable with triaging, examining, and diagnosing patients in a virtual platform.

Workings Towards Better Telehealth for Tomorrow

By working to build robust guidelines and measurements for telehealth today, we can secure a better and more equitable, transparent, and accessible future for every patient. As the saying goes, “sooner rather than later” is necessary for healthcare to maintain quality for patients and providers. Without these issues ironed out, we may see smaller problems become amplified in the next few months and years.