The Design, Implementation, and Operational Management of a Comprehensive Quality Management Program to Support National Telehealth Networks

Abstract

The Veterans Health Administration (VHA) is a large integrated healthcare system with a mission to care for over 5.6 million Veteran patients annually. VHA, like other healthcare organizations, is challenged with providing access to care to those it serves when they live at a distance from a physical site of care. VHA has embraced telehealth as a way of delivering care at a distance and increase access to specialty care services. Since 2003 VHA has developed large national telehealth networks that provided care to 497,342 patients in fiscal year 2012, who received 1,429,424 episodes of care, and is recognized as a national leader in this field. To ensure the safety and effectiveness of its telehealth networks in their delivery of care VHA has implemented a dedicated quality management (QM) program for telehealth. QM data for telehealth are reviewed at 3-month intervals, and the procedures and processes in place to support telehealth in VHA are assessed biannually in an internal accreditation process called "Telehealth Conditions of Participation." This collegial, nonadversarial process has ensured that all designated telehealth programs meet minimal standards and disseminate best practice. As a result of VHA's QM program, telehealth services in VHA meet consistently high clinical outcomes and have received no adverse Joint Commission citations. The Joint Commission regularly assesses patients managed via telehealth under its tracer methodology reviews.

Identification of postoperative care amenable to telehealth

“…INTEREST IS EMERGING IN USING TELEHEALTH to increase access to care and improve efficiency of health care delivery. 1 Telehealth has been used to provide operative subspecialty consultation to rural patients and is routinely used by integrated health systems, including the Veterans Health Administration, to reach geographically dispersed patient populations. [2][3][4] Prior work has demonstrated that some postoperative patients can also be effectively managed using video, static image-based, or telephone-based care, but studies have been limited to small pilot or simulation studies with narrowly defined operative types and patient populations.…”

Reduced Cost and Mortality Using Home Telehealth to Promote Self-Management of Complex Chronic Conditions: A Retrospective Matched Cohort Study of 4,999 Veteran Patients

“…46 Mayo and WSD studies and systematic reviews of HT do not detail EHR usage and its operation across the continuum of care. Care coordination, information technology, and quality management tools (elements of VHA's CCHT program) are well described, 15 and they reduce mortality and hospitalizations in CDM. 47 CDM patients usually have several volumes of written charts, often inaccessible while the individuals are in transit between sites of frequent clinic visits and hospital admissions.…”

“…CCHT was standardized with development of (1) an operations manual, (2) training curriculum, (3) staff competency testing, (4) information technology platform, (5) clinical coding schema, and (6) quality management processes. 15 Over a 10-year period, CCHT patient numbers increased from 2,000 to 89,000 ( Fig. 2) with CCHT programs in all 152 Veterans Administration medical centers.…”

The Growth of Telehealth Services in the Veterans Health Administration Between 1994 and 2014: A Study in the Diffusion of Innovation

“…In FY2011 VHA established pilot programs for tele-ICU to provide remote intensivist support to VAMCs with challenges in recruiting and retaining these clinicians and developed a clinical lead for tele-ICU. VHA consolidated its ''conditions of participation,'' an internal accreditation processes for HT, CVT, and SFT, into a combined assessment as part of a comprehensive quality management approach to telehealth 46 and incorporated tele-ICU and teledermatology into this process. Of the veteran patients whose care was supported by telehealth in VHA, 47% lived in rural areas in FY2013.…”