While telehealth has been evaluated in thousands of research studies, there is not enough evidence about how effective it is in order to shape policy decisions, according to a draft report from The Agency for Healthcare Research and Quality (AHRQ).
AHRQ, which is part of the U.S. Department of Health and Human Services (HHS), released a 52-page draft report to provide a framework and an evidence map of the available research regarding the impact of telehealth on health outcomes and healthcare utilization that can be used to inform policy and practice decisions and guide future work. The report is open for public comment until Jan. 6, 2016 and could guide policymakers in the development of legislation.
The AHRQ study was requested by Senators Bill Nelson (R-Fla.) and John Thune (R-S.D.), who asked for a literature review on the value of telehealth and remote patient monitoring, particularly for the chronically ill, with a focus on expanding access to care and reducing costs. A coalition of stakeholders, including several medical, patient advocacy and industry groups, supported the call for a report in a letter sent to Nelson and Senator Susan Collins (R-Maine).
The request for a review 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,” the AHRQ report stated.
AHRQ also noted that a key policy consideration is how telehealth might figure into new service delivery and payment models.
“Carrying out telehealth research under models of value-based care presents an important opportunity for future work, as any intervention or innovation that delivers care in more coordinated and efficient ways could be of great benefit to organizations entering into shared-risk models,” AHRQ noted in the study.
Barriers to telehealth adoption include a lack of evidence-based research, sustainability, lack of provider support, reimbursement, scalability and licensure, the report said.
According to AHRQ, studies have proven the value of telehealth interventions to produce positive results when used in the clinical areas of chronic conditions and behavioral health and when telehealth is used for providing communication and counseling and monitoring or management.
“Although we found that many reviews are not structured or conducted in a way that would support current decisions related to telehealth,” the agency noted in the report.
AHRQ recommends a two-pronged approach to advance telehealth. Additional research is needed is needed in a variety of clinical topics and for different healthcare functions for telehealth, according to the study.
“Finally, there clinical areas and roles for telehealth that do not yet have a sufficient evidence base to support important decisions about practice and policy and in these cases, more primary research is needed rather than more systematic reviews. We identified triage in urgent/primary care, management of serious pediatric conditions and the integration of behavioral and physical health as three potential topics for more primary research,” AHRQ stated in the study.
In addition, the second approach identified by AHRQ is further research into new organizational and payment models. “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. 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 report stated.