The report “Using Telehealth to Improve Quality and Safety: Findings from the AHRQ Portfolio” was prepared by the National Resource Center for Health IT. The report focuses on grants in the health IT portfolio that use telehealth to provide provider-to-provider communication with the patient both present and absent, plus use technology for telemonitoring and for health education.
According to the study, AHRQ HIT grantees in developing, implementing, or evaluating telehealth interventions reported:
- It is very important to do pilot testing prior to implementing the technology so that telehealth will not introduce new error sources into the clinical processes
- In the area of patient safety and the quality of care, one project demonstrated that remote pharmacy services provided to rural hospitals during irregular hours can more effectively detect and prevent dangerous medication errors than traditional methods. This can be attributed to pharmacists manually reviewing night and weekend orders first thing in the morning before turning to day shift activities.
- Implementing telehealth is not always easy since there can be challenges with telehealth equipment. On one project, vendor supplied home monitoring devices failed to work on a regular basis. As a result, one-third of the patients enrolled in the study became frustrated and stopped using the devices. Two projects reported that the video camera equipment did not provide adequate resolution to yield clear images for small pills and patient wound areas.
- Reimbursement for telehealth has been slow to be accepted, however, AHRQ funded projects are working with regional payers to secure reimbursement. One AHRQ funded project agreed to measure component healthcare costs and to demonstrate to regional payers, that there are cost savings when using telehealth. The project investigated specific areas concerning the impact of the early diagnosis on the initiation of treatment, the ability to manage chronic illness via telehealth as opposed to emergency care, and the positive effects of using telehealth to provide continuity of care
- Smaller organizations in the grant program reported that they need technical support 24/7. Without round-the-clock support, the grantees said that patient safety can be negatively impacted with critical patient services
- Telehealth systems need to be integrated with electronic health record systems to promote continuity of care across clinical settings particularly when facilitating medication reconciliation
- Telehealth systems can support team-based care. In one project, telehealth was used to connect nurses at 10 community hospitals with a remote pharmacist after normal hours and was successful. In another project, telehealth was used to create online communities among clinicians and was able to address community health issues with specialists and community providers
- Security versus speed is a problem. A Virtual Private Network (VPN) can be used to provide a secure way to establish point-to-point connections for telehealth visits. Currently connections using VPNs can be slow, especially when one end of the connection does not have a high speed connection to the internet
- Low resolution videos and images require less bandwidth than high resolution quality videos, but they may provide poorer quality images. However, in some cases, there is enough detail to permit clinical diagnosis
- To successfully implement telehealth systems without disrupting workflow, staff training is critical
Go to http://healthit.ahrq.gov/images/dec08telehealthreport/telehealth_issue_paper.htm to read the full report.