Researchers Propose Transformative Framework for Delivering Virtual Care

CLEVELAND – The COVID-19 pandemic has caused an extreme and immediate rise in the use of virtual healthcare. By April of 2020, telemedicine visits accounted for 13 percent of all medical claims, compared with 0.15 percent in April of 2019. This is an 86-fold increase. In “Ensuring Quality in the Era of Virtual Care,” published this month in the Journal of the American Medical Association (JAMA), the authors discuss the growing popularity of virtual care in an environment that has had limited discussions about its quality and trade-offs.

For instance, while current virtual encounters, such as for prescription refills or mental health counseling are broadly accepted, clinical practices that accompany a conventional in-office visit, such as recording blood pressure, may not generalize to the virtual setting. It’s a system that can increase timeliness at the expense of effectiveness.

The viewpoint piece from Peter J. Pronovost, MD, PhD, Chief Quality & Clinical Transformation Officer at University Hospitals and Professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine and School of Nursing, Case Western Reserve University, and Kurt R. Herzer, MD, PhD, MSc, Senior Advisor for the Center for Medicaid and Medicare Services and Adjunct Assistant Professor at Johns Hopkins Medicine, states that increased responsibility accompanies an increase in virtual care appointments.

The highest priorities of medicine are to avoid patient harm and deliver evidence-based care. In 2001, the Institute of Medicine described high-quality care as being safe, effective, efficient, timely, patient centered, and equitable. The viewpoint published in JAMA uses that framework to assess the current state and challenges of virtual care.

The piece suggests three principles to guide development going forward.

“We determined virtual care should achieve comparable safety and effectiveness to traditional care,” said Dr. Pronovost. “Secondly, it should accomplish a net increase in efficiency within the health care system. And third, virtual care should be respectful of patient preferences and values and not exacerbate health care disparities within a population.”

As a variety of wearables, remote medical devices and mobile apps enable more virtual care, physicians’ fundamental duty to patients remains unchanged. To ensure virtual healthcare is not only prevalent, but also successful, health systems, health plans, and health technology companies should ultimately demonstrate that it represents an effective, efficient, and equitable contribution to the U.S. health care system.

You can read the full article “Ensuring Quality in the Era of Virtual Care” in JAMA by clicking here.