How to boost physician telehealth adoption with a clinical quality program

Though the number of virtual medical appointments is projected to surpass that of in-office visits within the next four years, some physicians are still reluctant to buy in to the technology.

Of the barriers to this inevitable "sea change," according to Peter Antall, MD, chief medical officer of American Well, the most pressing challenges stem from a combination of physicians' perceptions of virtual care technology and the technology's incompatibility with existing clinical workflows.

Dr. Antall cited four major issues keeping physicians from adopting telehealth, based on findings from American Well's 2019 Physician Survey: uncertainty around reimbursement, lack of physician buy-in, poor leadership support and, perhaps most pressing, questions about clinical quality.

"Of physicians who are unwilling to use telehealth, upwards of 70 percent cite concerns about quality or concerns about the scope of care and other such clinical matters,” he said, necessitating the implementation of robust guidelines to ensure the quality of any virtual care offering.

During a Jan. 23 webinar sponsored by American Well and hosted by Becker's Hospital Review, Dr. Antall and Pei-Huey Nie, MD, vice president of medical affairs at Aligned Telehealth, outlined the components of a successful telehealth quality management program.

American Well's physician-owned and -operated medical practice, the Online Care Group, has in place a multi-pronged quality management program that takes advantage of several digital tools to boost the quality of care delivery. The program combines raw visit metrics; Ongoing Professional Performance Evaluation and Focused Professional Practice Evaluation programs; feedback from patients, clients and staff; and monthly scorecards.

Much of this quality-ensuring initiative is enabled by the data-heavy nature of telehealth, Dr. Antall explained: "In telehealth, we have more and different data than you would in brick-and-mortar quality management."

He continued, "We know, for example, exactly to the second how long a patient waited for a visit, whether it was on-demand or a scheduled visit. We know exactly to the second how long the visit lasted. And we have a comprehensive record — documentation, notes, secure messaging — that is able to be reviewed for quality."

Using this and other data to inform Aligned Telehealth's own clinical quality management program has enabled the virtual care provider to vastly outperform its major competitors in response time. The telepsychiatry company, which became a part of American Well in November 2019, has developed its own set of provider performance metrics to track quality, Dr. Nie explained, similar to the Online Care Group's scorecard.

"We have an Aligned internal dashboard that we use to determine how folks are doing," she said. "The metrics tracked on this interface dashboard — there are about 17 of them that we've identified from working with Joint Commission sites and my time at the [American Telemedicine Association] standards committee."

Those metrics track components such as the timeliness of an encounter, the monitoring of a patient's condition, rule-outs and justification for a diagnosis, how complications were anticipated and addressed, medical records completion, the appropriateness of the billing codes and more.

Beyond keeping response times significantly lower than those of its competitors, Aligned Health's metrics-tracking dashboard also allows providers to more easily track their progress, holding them "directly accountable for their performance metrics," according to Dr. Nie, giving them a direct role to play in guaranteeing the quality of the telehealth program. 

View the full webinar here.

More articles on telehealth:
How UCHealth bridged tech architecture and clinical expertise within its virtual health program
Providence targets clinician burnout by expanding virtual mental health services for employees
Children's Hospital Colorado launches remote virtual second opinions

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