By ECRI
Telehealth programs were implemented with great speed this past year, but not likely with the depth of analysis required to assure their long-term success. Telehealth is here to stay, but programs that were introduced or expanded to meet the emergency needs of the COVID-19 pandemic may not be configured to provide optimal patient care. ECRI delved into the problems and challenges associated with rapid telehealth adoption as topic No. 3 on its list of the Top 10 Health Technology Hazards for 2021.
The COVID-19 pandemic prompted health care delivery organizations across the United States to rapidly implement or expand telehealth technologies and programs, sometimes in a matter of days or weeks. To illustrate the point: the U.S. Department of Health and Human Services reports that the number of Medicare primary care visits that were provided through telehealth increased from less than one percent in February 2020 to more than 40% in April 2020 (0.1% versus 43.5%; see: HHS Issues New Report Highlighting Dramatic Trends in Medicare Beneficiary Telehealth Utilization amid COVID-19.)
The rapid adoption of telehealth technologies for various use cases in 2020 was driven by the need for health care organizations to continue providing services during stay-at-home orders, to conserve personal protective equipment (PPE) and to protect clinical personnel and patients. This shift was aided by government funding provided in the CARES Act, relaxed enforcement of HIPAA regulations and policy changes instituted by the U.S. Centers for Medicare & Medicaid Services (CMS) that expanded its list of covered telehealth services during the pandemic.
While the sudden change has been necessary to meet the immediate need, the rapid deployment and expansion of telehealth solutions may create its own problems and challenges. “Challenges could impact both patients and providers,” notes Juuso Leinonen, a senior project engineer in ECRI’s device evaluation group, “particularly as facilities transition from the pandemic response to new telehealth care delivery models.” Addressing these challenges may result in the eventual need to switch, modify, reconfigure or completely cease the use of some of these technologies, software, programs or workflows.
Following are seven tips from ECRI for safeguarding patient care and ensuring the long-term success of a telehealth program. Failure to address these challenges could adversely affect patients – it could lead to suboptimal treatment, increase the risk of medical errors or hinder certain populations from accessing care, for example – and it could put the patient’s and the facility’s data at risk.
- Assess whether the technologies are suitable for long-term use
Given the need for rapid implementation and expansion, some technology assessment steps that are part of the normal process may not have been conducted. As a result, the technologies adopted may not be suitable as a long-term telehealth solution or may not be the best long-term option for the facility. If assessment steps were skipped, take the time to go back and subject telehealth components to appropriate reviews as specified in facility policy. - Be prepared for regulatory or reimbursement changes
ECRI stresses the need for a transition plan for any technologies and programs that are being used under the auspices of temporary regulations or policy changes. HIPAA compliance exemptions and temporary CMS policy changes that fueled the telehealth expansion may expire or change once the public health emergency subsides. For example, commercial video platforms that may have been adopted during the pandemic may not be viable when enforcement of HIPAA compliance resumes. - Identify and correct workflow inefficiencies
Review the current telehealth clinical workflows and how they integrate with the existing practices and systems to identify aspects that may lead to inefficient or suboptimal patient care. Consider challenges such as:- Distractions that can exist in either the provider or the patient environment during a telehealth encounter
- Physician fatigue and burnout due to numerous back-to-back visits without adequate time to regroup between patients
- Inability to weigh patients during telehealth encounters, increasing the risk of medication errors
- Inadequate technology resources to support telehealth encounters
- Poor coordination of care
- Verify that telehealth system users are appropriately trained
Expansion of telehealth technologies has resulted in many additional clinical staff being required to use these solutions to deliver care. During rapid implementations of telehealth programs or expansions of existing ones, user training may have been overlooked. “Ease of use can’t be assumed,” explains Leinonen. “Usability concerns have been some of the core issues identified during ECRI testing of telehealth technologies.” - Establish a clear patient-selection methodology
Not all patients are good candidates for telehealth. For example, a telehealth visit may not be effective for patients who are not comfortable using technology or who have diminished cognitive ability. Some patient conditions will require an in-person visit. Offer alternatives or technology support to patients who are not comfortable with the use of the telehealth technologies. - Provide alternatives for patients who lack telehealth access
Patient access to the hardware and other resources needed for using telehealth services – resources that include digital devices, broadband access, Wi-Fi capability, reliable cellular connection and private space – is not equal for everyone. Connectivity options may be limited based on the geographical location of the patient and the service provider. Recognize that access to technology will differ among patients and consider alternatives when appropriate. - Mitigate unaddressed cybersecurity risks
A rushed implementation could lack adequate cybersecurity controls, putting the patient’s and the facility’s data at risk. Risks can be introduced through the expanded use of connected medical devices, such as those used in remote patient monitoring, or can result from the need to rely on a personal cellular device and the use of a personal wireless network, which may lack common security controls (e.g., up-to-date software, use of secured wireless networks). Additionally, the reliance on telehealth solutions to deliver care requires access to a reliable network and high system availability. This is especially crucial for any emergency telehealth services.
Effective cybersecurity measures can protect patient and facility data and can help minimize downtime. ECRI recommends conducting a security risk assessment for any implemented telehealth solution to verify that facility expectations are met and that appropriate security controls are in place.
Summing Up
“Telehealth technology expansion is here to stay. There’s no going back,” explains Leinonen. “But what programs will look like as the dust settles after COVID-19 is unknown.” Regulatory, reimbursement, reliability and usability factors all will help shape future telehealth technologies and programs. His bottom-line? “Established telehealth programs may need to evolve in order to be viable in the post COVID-19 world.”
– This article is adapted from ECRI’s Top 10 Health Technology Hazards for 2021 and related content, including a series of ECRI webcasts addressing Telehealth during the COVID-19 Pandemic. Each year, ECRI produces its Top 10 Health Technology Hazards report to help hospitals direct their time and energy toward technology management activities that can have the greatest impact on patient safety. An Executive Brief version of the report is available for complimentary download at www.ecri.org/2021hazards. The full report, accessible to ECRI members, provides in-depth discussion of each hazard, including detailed steps that organizations can take to prevent adverse incidents. To learn more, contact ECRI at 610-825-6000, ext. 5891, or by email at clientservices@ecri.org.