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National Quality Forum Issues Draft Telehealth Framework

June 13, 2017
by Heather Landi
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The National Quality Forum (NQF) issued a report that outlines a measure framework, with a prioritized list of measure concepts, and guiding principles for future telehealth measurement. 

NQF acknowledges that telehealth offers tremendous potential to transform the healthcare delivery system by overcoming geographical distance, enhancing access to care, and building efficiencies.

This report is a project initiated by the U.S. Department of Health and Human Services (HHS) for NQF to convene a multi-stakeholder committee to recommend various methods to measure the use of telehealth as a means of providing care. The committee was charged to develop a measurement framework that identifies measures and measure concepts and serves as a conceptual foundation for new measures, where needed, to assess the quality of care provided using telehealth modalities.

The goal of the project was to facilitate the identification of the most appropriate way to ensure clinical measures are applied to telehealth encounters in order to measure quality of care and to guide the future development of telehealth-related measures.

Public comments on the NQF draft framework are due June 30.

“This report and the conceptual framework herein serve as the foundation for future efforts by measure developers, researchers, analysts, and others in the healthcare community to advance quality measurement for telehealth,” the NQF committee states in the report. “By identifying some of the highest-priority areas for measurement, this report may support the development of measures that incorporate into a telehealth environment as part of an iterative development process. Measurement based on iterative and continuous learning will successfully inform future telehealth quality improvement efforts, including emerging areas such as patient empowerment and care coordination.”

Throughout the project, NQF solicited input from NQF’s multi-stakeholder audience, including NQF membership and public stakeholders at key points throughout the project.

For this study, the NQF committee examined four modalities of telehealth—live video (synchronous), store-and-forward (SFT) (asynchronous), remote patient monitoring (RPM) and mobile health (mHealth).

The report identified five domains by which to measure telehealth—access to care, cost, cost effectiveness, patient experience and clinician experience.

NQF committee also consolidated the measure concepts into a final list of six key areas for measurement—travel, timeliness of care, actionable information, added value of telehealth to provide evidence-based best practices, patient empowerment and care coordination.

The committee recommends these six areas as having the highest priority overall for measurement in telehealth, according to the framework report.

The report also examined the impact of the Medicare Access and CHIP Reauthorization Act (MACRA) on the telehealth framework, as MACRA represents a new mechanism of reimbursement for telehealth services for Medicare providers.

The NQF Committee also noted future considerations as the development and identification of measures related to telehealth continues. One consideration is that the use of various telehealth modalities demonstrates a positive effect on quality health outcomes, processes, and costs. Further, existing quality measures to evaluate the effectiveness and benefits of telehealth must be widely accepted and impactful, the Committee notes. And, the committee points out the need for consistent definitions through proposed measure concepts and existing measures.


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