Telehealth Advocates Grapple with Applying Meaningful Quality Metrics

| URAC Staff
Doctor with Medical Healthcare Research Overlay Concept

Quality is an elusive concept. When used as a noun, the Oxford English Dictionary defines it as, "the standard of something as measured against other things of a similar kind; the degree of excellence of something."

Given its complexities, it should come as no surprise to learn telehealth practitioners sometimes struggle with how to articulate and measure quality in their own programs.

To hear panelists at the URAC Telemed Leadership Forum 2019 in Washington, D.C. tell it, the secret is about clarity and simplicity.

“Start with a clear articulation and understanding of your strategic vision to align metrics important to you, clearly that’s the most important thing,” said Dr. Judd Hollander, senior vice president for healthcare delivery innovation, Thomas Jefferson University.

To Hollander, quality is quality across the entire healthcare spectrum. “There’s nothing different, and the more different we make it the more they won’t pay us for services and will ask us for more ridiculous things,” he added.

His mantra? Keep it simple. “Don’t hold telehealth to a higher standard than the care in a traditional emergency department,” the telehealth advocate advised. If kept simple, “we’ll move faster and do much better for our patients,” he said.

Metrics are a key to success, too, said Dr. Martin Kohn, consultant. Do you have a reasonable set of measures in place? Is the program patient-centric? Will its benefits be sustained over time? “Those are the criteria I use to judge if a project has been successful,” he said.

However, there are clearly nuances to address when assessing different types of telehealth, experts agreed.

For example, while it’s exciting to see the usage of telehealth advancing in behavioral health treatment, patient privacy is a bedrock to providing quality care, said Dr. Stephen Locke, chief medical officer, iHope Network. When assessing the quality of a telehealth initiative, Locke advised looking in four areas:

  • Is it evidence-based? In other words, “other indicators pale by comparison if” you cannot demonstrate clinical effectiveness using the treatment, he said.
  • Does the system provide for collaborative care? As with many other medical practices, “integrated care provides better outcomes” as opposed to silos, Dr. Locke said.
  • Does the system provide for a continuity of care?
  • Does the system have built-in safety protocols? “Does the telehealth program integrate with other resources to protect patients,” Dr. Locke said. It’s a serious matter. Patients with severe mental health issues such as depression are at a relatively high risk for suicide, he noted.

The legal standard for quality is the same in terms of untoward outcomes, whether care was delivered at home or in a hospital, Dr. Locke said. It depends on the appropriateness of the setting. “If the care shouldn’t have been delivered remotely that’s the responsibility of the clinician who delivered it,” he said. “You can’t hide behind telemedicine as a distinctive delivery system as a way to protect yourself if something goes wrong,” Dr. Locke added.

Behavioral healthcare is a different type of service to consider, though, because most treatments are delivered in smaller offices or by sole practitioners, as opposed to the larger institutions handling most other healthcare services such as emergency room visits and surgeries, Dr. Locke said. Solo practitioners have a much bigger challenge when it comes to “their ability to pay attention to the quality standards we might expect in an institution,” he said.

Dr. Locke stressed that access itself must be an important part of the value calculation when assessing telehealth programs. “If there’s no care at all, the quality is zero,” he said, noting wide swaths of the country and underserved by on-site mental healthcare practitioners. Telehealth, either as a standalone service or paired with in-clinic care, “has the potential to improve the access equation.”


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