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AHRQ Calls for More Validation of Telehealth

A draft report cites thousands of instances in which telehealth, telemedicine, eHealth and mHealth are mentioned, but not enough evidence that they're effective. It also calls for more study of value-based care models.

- Although there have been hundreds of reviews and hundreds of thousands of mentions since 2006, telehealth is still very much a cutting-edge technology – and not validated enough in most cases that legislators can draft adequate policies or standards.

That’s the conclusion of a 52-page draft report from the Agency for Healthcare Research and Quality, which is advocating for more research and an exploration of new organizational and payment models. The report is open for public comment until Jan. 6, 2016.

The AHRQ study was requested by Sens. Bill Nelson (R-Fla.) and John Thune (R-S.D.), and supported by a coalition of stakeholders who’d sent a letter to Nelson and Senator Susan Collins (R-Maine). In its final form, it’s expected to guide policymakers in the development of legislation.

As noted by the AHRQ researchers, though, while there’s been a lot of action in telehealth, there hasn’t been much proof that the concept is working.

“The request for a systematic review of ‘the growing body of evidence demonstrating the value of telehealth technologies’ is rooted in a belief that telehealth has the potential to produce positive benefits, a desire to promote the effective use of telehealth, and motivation to remove barriers to its use,” the AHRQ said in its report. “Telehealth has been described as having great promise in the sense that it could leverage the $30 billion investment in electronic health records that ONC has made in the last half-decade through the Health Information Technology for Economic and Clinical Health (HITECH) Act. While the potential benefits and possible uses have been extensively enumerated and described (e.g., improving quality, promoting safety, and expanding access), there is also a body of literature that outlines barriers as well as challenges to implementation and widespread adoption of telehealth.”

Those barriers, the report said, include a lack of evidence-based research, sustainability, lack of provider support, reimbursement, scalability and licensure.

According to the AHRQ, studies have proven the value of telehealth in managing chronic conditions and behavioral health, as well as providing platforms for communication and counseling and monitoring and management. In other areas – consultation, acute care, maternal and child health, triage in urgent and primary care, management of serious pediatric conditions and the integration of behavioral and physical health.

Researchers noted that while there are thousands of instances in which telehealth is cited, “the existence of research on a topic does not guarantee that evidence can be used to support practice and policy decisions.” They also noted that the definitions of “telehealth” and “telemedicine” are often interchanged – the National Library of Medicine, in fact, lists them as synonyms in its Medical Subject Headings, as does the Health Information and Management Systems Society (HIMSS) – and that eHealth and mHealth have also been added to the mix by the Office of the National Coordinator of Health Information Technology.

Finally, the AHRQ said more work needs to be done in examining how telehealth can be applied to value-based models of care.

“Going forward, research should be conducted in emerging models of care, particularly value-based models where use of telehealth may improve the ability to share risk and attain quality and related outcomes,” the draft report concluded. “These studies of telehealth should consider combinations of applications of telehealth and outcomes that are important in these new models and evaluate the specific contribution telehealth can make in these contexts.”

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