National Quality Forum: Creating a Framework to Support Measure Development for Telehealth
National Quality Forum Final Report. AUGUST 31, 2017.
Telehealth offers tremendous potential to transform the healthcare delivery system by overcoming geographical distance, enhancing access to care, and building efficiencies.1 The Health Resources and Services Administration (HRSA) defines telehealth as “the use of electronic information and telecommunications technologies to support and promote clinical healthcare, patient and professional health-related education, public health and health administration.”2 Although it does not represent all existing definitions for this important area of health information technology (health IT) across both the private and public sectors,3 there is general consensus that telehealth supports a range of clinical activities, including:
- Enhancing interactions among providers to improve patient care (for example, consultation with distant specialists by the direct care provider);
- Supporting provider-to-provider training;
- Enhancing service capacity and quality (for example, small rural hospital emergency departments and pharmacy services);
- Enabling direct patient-provider interaction (such as follow-up for diabetes or hypertension; or urgent care services);
- Managing patients with multiple chronic conditions from a distance; and
- Monitoring patient health and activities (for example, home monitoring equipment linked to a distant provider).4
The U.S. Department of Health and Human Services (HHS) called upon the National Quality Forum (NQF) to convene a multistakeholder Telehealth Committee to recommend various methods to measure the use of telehealth as a means of providing care. The Committee was charged with developing a measurement framework that identifies measures and measure concepts and serves as a conceptual foundation for new measures, where needed, to assess the quality of care provided using telehealth modalities.
This report and the conceptual framework herein serve as the foundation for future efforts by measure developers, researchers, analysts, and others in the healthcare community to advance quality measurement for telehealth. By identifying some of the highest-priority areas for measurement, this report may support the development of measures that incorporate into a telehealth environment as part of an iterative development process. Measurement based on iterative and continuous learning will successfully inform future telehealth quality improvement efforts, including emerging areas such as patient empowerment and care coordination.
1. Koller S, Hofmann-Wellenhof R, Hayn D, et al. Teledermatological monitoring of psoriasis patients on biologic therapy. Acta Derm Venereol. 2011;91(6):680-685.
2. Armstrong AW, Johnson MA, Lin S, et al. Patient-centered, direct-access online care for management of atopic dermatitis. JAMA Dermatol. 2015;151(2):154-160.
3. O’Malley G, Clarke M, Buris A, et al. A smartphone intervention for adolescent obesity: study protocol for a randomized controlled non-inferiority trial. Trials. 2014;15:43.
4. Chumbler NR, Kobb R, Harris L, et al. Healthcare utilization among veterans undergoing chemotherapy: the impact of a cancer care coordination/home-telehealth program. J Ambul Care Manage. 2007;30(4):308-317.
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