The National Quality Forum (“NQF”) has published a draft report (“Report”) recommending various methods to measure the use of telehealth. By way of quick background, NQF is a non-profit, nonpartisan organization that seeks national collaboration to improve health and healthcare quality through measurement. The Department of Health and Human Services (“HHS”) requested NQF to convene a multi-stakeholder committee to recommend various methods to measure the use of telehealth as a means of providing care. Among other things, the Report analyzes the best way to ensure clinical measures are appropriately applied to telehealth, proposes a measure framework, sets some guidelines for future telehealth measurement, and identifies measurement gaps.
To help develop a telehealth measurement framework, NQF began by conducting a comprehensive scan identifying existing measures and potential measure concepts related to telehealth. As explained in the Report, the “framework is a conceptual model for organizing ideas that provides high-level guidance and direction on priorities for what is important to measure in telehealth and how measurement should take place in order to assess its impact on healthcare delivery and outcomes.” The Report analyzed reports and white papers from organizations such as the American Telemedicine Association, the Health Information Management and Systems Society, and the Office of the National Coordinator for Health Information Technology.
The telehealth measurement framework comprises of three categories:
- Domains – a categorization/grouping of high-level ideas and measure concepts that further describe the measurement framework;
- Subdomains – a smaller categorization/grouping within a domain; and
- Measurement Concepts – an idea for a measure that includes a description of the measure, including planned target and population.
The four domains are: i) access to care; ii) financial impact/cost; iii) experience; and iv) effectiveness. Without delving too much into each domain, there are a couple of points to make. The access to care domain addresses whether the use of telehealth allows individuals to obtain clinical services effectively and whether hospitals are able to provide certain services such as emergency services. On the cost domain, the Report notes the “sparse” research regarding telehealth financial impact and cost issues that currently exists. Unlike the Congressional Budget Office, however, NQF is willing to examine less travel time and less time lost at work as part of its evaluation of the financial impact of telehealth.
Significantly, the Report also provides a list of six key areas for telehealth measurement (not in order of priority):
- Timeliness of Care
- Actionable Information
- Added Value of Telehealth to Provide Evidence-Based Best Practices
- Patient Empowerment
- Care Coordination
The Report concludes by providing future considerations for the measurement framework, including development of consistent, standard definitions. Among other things, aspects of the Report I did not discuss include an in-depth discussion of the subdomains and the impact of MACRA. All in all, the Report makes for thought-provoking reading, and stakeholders are encouraged to provide comments to NQF by June 30, 2017.
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