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7 Tips for Including Patient Safety in Telemedicine Programs

In an AHRQ commentary, Partners Healthcare executives Joseph Kvedar and Stephen Agboola say patient safety has to be figured into every step of the telehealth process.

- Health systems have been slow to adopt telemedicine due to concerns over patient safety. But executives at Partners Healthcare’s Center for Connected Health say the technology has done more good than harm and should be embraced more readily.

In a commentary for the Agency for Healthcare Research and Quality (AHRQ), Joseph Kvedar, MD, Partners Healthcare’s vice president of connected health, and Stephen Agboola, MD, MPH, associate director of connected health data science & analytics, say healthcare providers and innovators should be mindful of the risks as they map out a telemedicine strategy.

“New technologies and care models come with attendant risks,” they wrote. “Telemedicine has demonstrated many positive effects on care. Rather than stop the forward progress, we argue for a more thoughtful, continuous safety improvement process that could start from the moment of project conception.”

Agboola and Kvedar – whose annual Partners Healthcare Connected Health Symposium is one of the top digital healthcare conferences in the country – point to a number of studies that “have shown that telemedicine promotes continuity of care, decreases the cost of care and improves patient self-management and overall clinical outcomes.”

Among the results of those studies, the two executives note, are findings that telemonitoring of heart failure patients reduced all-cause mortality by 15 percent to 40 percent and heart failure-related hospitalizations by 14 percent to 36 percent. Another study saw three times less physician-related medication errors when rural emergency department and pediatric critical care physicians consulted by real-time video with specialists.

Also, a study of ambulatory patients with diabetes found that mHealth-based follow-up care detected more treatment-related adverse effects (almost 60 percent) compared to a home care nurse (30 percent) or patient detection (11 percent).

Conversely, Agboola and Kvedar said few studies have been conducted on the overall impact of telemedicine on patient safety.

And those concerns are valid. Some fear that virtual visits could miss something that would otherwise have been caught in an in-person visit, increasing the risk of a medical error. One study, Agboola and Kvedar note, identified telemedicine as a “significant root cause” in 32 cases that ended in catastrophic outcomes, including death and more than $12 million in malpractice settlements.

Similarly, the two Partners executives point out that today’s digital health innovators are coming from fields other than healthcare, and may not have the experience or vision to build the right safeguards into their mHealth and telehealth solutions. This is particularly true in the consumer-facing mHealth market, where apps and products may not have gone through formal safety or efficacy testing.

After analyzing both sides of the ledger, Agboola and Kvedar offered seven guidelines for improving patient safety in mHealth or telehealth programs:

  1. Start at the beginning, and make sure patient safety is addressed at all stages of the program’s life cycle;
  2. Integrate safety testing in all usability and efficacy trials, regardless of whether they’re conducted in academic medical settings;
  3. Make sure all data security and encryption protocols are up to date;
  4. Include input from regulatory, professional and healthcare organizations in creating consensus-driven guidelines, operational protocols and standards, and make sure all are updated regularly;
  5. Make sure all possible risks are disclosed prior to patient enrollment;
  6. Create platforms that enable clinicians to document their telehealth use and integrate those services into their workflows; and
  7. Improve engagement in telehealth services for patients with low health literacy and those who speak other languages.

“Although some telemedicine programs can prevent medical errors, known and emerging threats to patient safety are real. Therefore, there is a need to increase research efforts evaluating the impact of telemedicine on patient safety,” Agboola and Kvedar concluded. “Ultimately, we need to balance our commitment to the ethical principle of nonmaleficence (do no harm) with the need to adopt technology-driven innovations in healthcare to enhance quality and efficiency. Doing so should allow us to use these technologies to improve patient safety.”

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