During the pandemic, health care institutions rushed to embrace telehealth, a technology that has been around for two decades. But the ability to measure the quality of care delivered by this digital innovation—or even to document it in billing systems—lags well behind. This has created “an unsettled health care system,” according to Eric Schneider, M.D., executive vice president of the Quality Measurement and Research Group at the National Committee for Quality Assurance (NCQA).
One of the nation’s leading health care quality researchers, Dr. Schneider made this observation as the featured speaker at the January 19, 2023 webinar sponsored by United Hospital Fund’s Quality Leaders Forum. Prior to joining NCQA in January 2022, Dr. Schneider was senior vice president for policy and research at the Commonwealth Fund and has been studying digital innovations to improve quality of care since the mid-1990s.
Although telemedicine and other digital technologies are far from novel, health care providers are still working out how to optimize these tools in ways that can transform delivery of care, he said. “Prior to the digital era, innovations were primarily in the categories of drugs and devices, and it is easier to adopt changes to something that already existed.” Telemedicine, however, has emerged as a completely different category of innovation, and thus has the potential to disrupt both delivery of care and payment systems.
“Digital innovations are creating the need for new types of skills, roles, and processes,” Dr. Schneider said, citing remote patient monitoring and the use of artificial Intelligence for mental health delivery as just two such transformative examples. In addition, many of the companies developing these technologies have not traditionally operated in the health care space—another disruption.
Consequently, telehealth and other digital tools present a big challenge for those health care professionals who use them, and for those who pay for those types of services. “We have to catch up to the possibility that our current standards and measures of quality may not capture the value of new ways of delivering care,” Dr. Schneider said. “How do we handle that? How do we monitor care?”
The large amounts of data generated by new digital technologies also present new challenges, and opportunities, he said. “Having more data means we can create much better-quality measures,” but the limited ability of many health care systems to exchange such data can create additional burdens.
Dr. Schneider compared telemedicine to the introduction of automated teller machines (ATMs) in the 1970s. At first considered a novelty, these now-ubiquitous machines transformed the relationship between banks and their customers, in ways that would have been hard to foresee when the first ATM was installed in 1969. In the same sense, “the pathway for digital tools to advance coordination in health care is not yet clear.”
He noted that it took years for ATMs to become commonplace, and a crisis to speed their adoption—the 1976 blizzard that paralyzed much of the east coast. In the same way, the COVID-19 pandemic might be the crisis that accelerates the scaling of digital technologies in health care, he said.
Some 26 health care professionals attended the seminar and Dr. Schneider’s remarks provided substantial content for lively conversation as the attendees broke into groups after his talk. They shared how their institutions are implementing these new digital tools.
The Quality Leaders Forum is a group of emerging and established health quality leaders committed to improving the delivery of high-quality care in the greater New York area. Members include alumni from the UHF/GNYHA Clinical Quality Fellowship Program and honorees from UHF’s Tribute to Excellence in Health Care. Members are invited to network and discuss current issues in health care quality with nationally recognized quality leaders and to pursue opportunities for sharing best practices.
Past Forum summaries can be found here.
UHF is grateful to Elaine and David Gould, whose generosity supports the Quality Leaders Forum.