Telehealth quality of care tool: web annex

Quality of care in services provided at a distance through modern telehealth technologies and methodologies is ever more relevant as this growing approach to the provision of health care, including its application in health promotion and disease prevention, has seen an exponential increase during and after the COVID-19 pandemic. Such fast growth calls for attention to quality, and so, it is critically important to implement appropriate audit and quality assurance in telehealth. The evaluation of telehealth services may require comparisons of health and health-care outcomes between the new telehealth service and the service provided in person, as well as an evaluation of the conditions and processes, which are unique to it. Quality strategies can assess or measure; assure by avoiding risk and error; and improve the quality of care by striving for change. Regarding quality assurance, the enabling service that needs to be set in place is that which assures high levels of care are offered via telehealth solutions. Based on previous recommendations and assessment frameworks, the WHO Regional Office for Europe developed a tool that serves as both a guidance and self-assessment instrument for telehealth services quality improvement that is useful at local, regional and national levels. The Telehealth Quality of Care Tool (TQoCT) was created through an iterative process, combining desk research and gathering knowledge from topic and country experts, and using a set of validation exercises. It is work-in-progress, to be used now by Member States, and it can benefit from their feedback for further improvements. An initial alignment with the ISO 13131:2021 standard was ensured as this guidance was regarded highly by several experts. However, more detailed work to integrate it would have required a longer period and further iterations. This tool should not be used or implemented by one individual in isolation. We envision that using the tool requires gathering a group of stakeholders to agree on the maturity level of a telehealth system through three components of quality of care – people centricity, clinical effectiveness, and safety – be it at the national, regional or organizational level. The creation of a network or ecosystem for telehealth, and a common understanding around quality of telecare, are immediate quick wins that can foster strategies for continuous improvement.

Telehealth quality of care tool

This first version of the Telehealth quality of care tool (TQoCT) is intended to be used by Member States (namely by focal points for patient safety and quality of care (QoC) and all other relevant parties of national telehealth ecosystems) or by individual health-care provider organizations. As more health and care moves to digital-based service provision, including the use of digital tools for supporting health interventions and care services provided at a distance, the quality of the care that is provided becomes more relevant. The quality of telehealth ultimately matters for increasing the adoption of this new paradigm of care because significant patient safety or QoC issues will ultimately undermine the trust populations and professionals have on this still somehow new way of practicing medicine and supporting the provision of modern and integrated care. Approaches to such quality standards benefit from common reference materials, and the TQoCT aims to aggregate these in a manner that stimulates reflection and action, helping countries and health-care organizations on their journey to mature, safe and high-quality telehealth service provision.