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Improving Quality and Safety of Telehealth

07/15/2021

By David W. Baker, MD, MPH, FACP, Executive Vice President for Health Care Quality Evaluation, The Joint Commission, and Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety

During COVID-19, telehealth has provided a critical way for patients to receive care. While telehealth is not a new way to deliver care, many health care organizations found themselves on a steep learning curve as they rapidly implemented this technology during the pandemic. 

In the July 2021 issue of The Joint Commission Journal on Quality and Patient Safety (JQPS), I raise several quality and safety questions about telehealth in an editorial, including:

  • What are the unique quality and safety issues in telehealth, especially during this transition period?
  • Is telehealth exacerbating disparities, or can it instead overcome access barriers? 
  • For telehealth visits by videoconferencing, how can we mitigate the negative effects of individuals’ limited skills in using computer technology and provide care for individuals with visual or hearing difficulties?
  • How can we improve the delivery of telehealth and seamlessly integrate this with in-person visits? 

Future of Telehealth
Telehealth has been around for many years, but there is still much to learn. Little guidance is available on which patients are appropriate for a pure telehealth visit and which should be seen in person. Many patients may benefit from a hybrid approach with an initial telehealth visit followed by a short in-person visit as needed. 

Additionally, while articles have been written about patients performing different elements of their physical exam while the clinician observes during a video visit, questions remain, such as: 

  • Are observed patient self-exams accurate and safe?
  • Are clinicians being trained adequately about how to optimally conduct a telehealth visit, including how to gain rapport with patients? 
  • Do we even know enough about optimal practice to provide useful training?
  • What other quality and safety issues in telehealth do we need to address? 
  • Some telehealth providers are recording encounters and reviewing these to assess quality. Should this be standard? 
  • Can video telehealth visits offer insights into patients’ lives and their ability to care for themselves at home that would not be possible through in-person office visits?

Call for Papers on Telehealth
JQPS is interested in publishing studies on telehealth, including retrospective analyses of quality and safety issues and prospective studies of strategies to improve quality, safety, access to care and utilization. 

A great example of this is the paper “Detecting and Assessing Suicide Ideation During the COVID-19 Pandemic,” in the July issue of JQPS. This study details how Kaiser Permanente Washington (KPWA) shifted focus from the technology and logistic aspects of telehealth to quality and safety during COVID-19. 

As detailed in this blog post, KPWA implemented a series of new processes and workflow changes to administer standard screening and monitoring questions at virtual visits and to complete structured suicide risk assessments for patients reporting frequent suicidal ideation during the pandemic. 

Telehealth is here to stay, and we have much to learn about how best to deliver care in this way. To learn more about submitting a paper, please visit the JQPS website. We look forward to hearing from you!

David W. Baker, MD, MPH, FACP, is the Executive Vice President for Health Care Quality Evaluation at The Joint Commission in Oakbrook Terrace, Illinois. He leads the Department of Standards and Survey Methods, the Department of Quality Measurement, and the Department of Research. He oversees the development of performance measures, standards, survey methods, and National Patient Safety Goals for all Joint Commission accreditation and certification programs. He is also Editor-In-Chief of The Joint Commission Journal on Quality and Patient Safety.