- The Agency for Healthcare Research and Quality (AHRQ) is looking for more evidence that telehealth can help in the management of patients with acute and chronic conditions.
The agency is looking for “scientific information submissions” that go beyond the published literature now being used for its review on Telehealth for Acute and Chronic Care Consultations, an effort led by the AHRQ’s Evidence-based Practice Centers (EPC) program. It’s specifically looking for evidence of clinical and economic outcomes, as well as any negative effects and whether those results apply across different settings.
The AHRQ, an arm of the Health and Human Services Department, has had a mixed reaction to telehealth and telemedicine in the past. A 52-page report issued last year indicated the agency sees the value of the technology in helping people with chronic diseases, but felt there hasn’t been enough validation to allow legislators to draft policies and standards.
“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,” the report continued. “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.”
As the nation’s healthcare system shifts to a value-based care philosophy, the AHRQ isn’t the only group looking to define the value of telehealth, telemedicine, mHealth, digital health, connected healthcare and all the other popular terms.
In its 2017 action plan, the Connected Health Initiative, a two-year-old offshoot of ACT | The App Association that’s been tasked with exploring the intersection of healthcare and technology, is including an in-depth discussion on how to define “effectiveness.”
Also underway is a year-long project launched by the National Quality Forum’s Telehealth Framework to Support Measure Development to “identify existing and potential telehealth metrics to identify gaps and develop a measure framework, prioritized list of measure concepts, and guiding principles for future telehealth measurement.”
“It is assumed that telehealth encounters are as effective as in-person encounters,” the foundation wrote in its description of the HHS-funded project. “Because telehealth is intended to replicate the interaction of a traditional healthcare encounter, it is expected that the clinical outcomes for patients would be the same independent of the modality of care. While there is a multitude of clinical measures that evaluate the effectiveness of healthcare interventions, less is known about the extent to which these measures assess or could be used to assess the effectiveness and overall quality of telehealth interventions, particularly in rural areas. What is needed is a measurement approach that takes into consideration the characteristics of telehealth and the challenges faced by rural healthcare providers and their patients.”
In its call for more data, published in the March 24 edition of the Federal Register, the AHRQ is asking five key questions:
- Are telehealth consultations effective in improving clinical and economic outcomes?
- Are telehealth consultations effective in improving intermediate outcomes?
- Have telehealth consultations resulted in harms, adverse events, or negative unintended consequences?
- What are the characteristics of telehealth consultations that have been the subject of comparative studies?
- Do clinical, economic, intermediate or negative outcomes (i.e., the outcomes in Key Questions 1, 2, and 3) vary across telehealth consultation characteristics (Key Question 4)?
In its report last year, the AHRQ said 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 – the results haven’t been conclusive.
“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 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.”
The agency is asking that any new submissions be sent to the Scientific Resource Center at the Portland (Ore.) VA Research Foundation within 30 days.