Viewpoint: 5 issues telehealth must address before permanent expansion 

If telehealth is going to provide value to the healthcare system, it must address issues such as health equity and disparities in healthcare while delivering safe and high-quality care, according to Shantanu Agrawal, MD, and Tejal Gandhi, MD.

For a Sept. 23 viewpoint article published in Health Affairs, Dr. Agrawal, president and CEO of the National Quality Forum, and Dr. Gandhi, chief safety and transformation officer at Press Ganey, shared five challenges telehealth must tackle if it is to be permanently expanded in Medicare.

Five goals to optimize the value of telehealth:

1. Implement telehealth to address health equity and decrease existing health disparities. Addressing equity will require a greater focus on culture and strategy rather than technology, so for telehealth, that will require implementing services that reach underserved patient populations and support access to broadband, devices and translation services.

2. Find issues within longitudinal care that can be amended by telehealth. Virtual care alone cannot replace longitudinal care. Patients will still require diagnostic testing, hospitalization and other institutional care, so introducing "tele-amendable" solutions that supplement care through digital apps and tools like remote monitoring will help providers and patients realize the full advantage of telehealth.

3. Manage quality and safety so it is improving within virtual care. To do this, healthcare organizations need a clear framework for measurements based the Institute of Medicine's six domains of quality with data points to assess the patient experience with telehealth services. This would include measure of equity and access, effectiveness, patient experience and safety.

4. Establish guidelines, clinical standards and expectations for both clinicians and patients to make sure telehealth is provided adequately and with no more risk than as a physical encounter.

5. Create a specific regulatory and policy approach that measures how appropriate a specific telehealth service is based on the patient's needs. For example, determine what types of issues warrant a video encounter versus phone call.

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