Nurses Advancing Telehealth Services in the Era of Healthcare Reform

Joelle T. Fathi, DNP, MN, BSN, RN, ANP-BC; Hannah E. Modin, MHA, B.A; John D. Scott, MD, MSc, FIDSA


Online J Issues Nurs. 2017;22(2) 

In This Article

Quality, Means, and Cost of Healthcare Delivery

Healthcare value has been defined as the health outcomes achieved, divided by each dollar spent. (Porter, 2010). In the current era of value-based care, intentional design of high quality clinical care delivery models are targeted to achieve better patient outcomes. Provision of high-value care is a major priority for all stakeholders, including consumers who are patients; purchasers represented by employers and individuals; and healthcare systems as suppliers of healthcare. The IOM has identified the necessity and utility of technology to achieve better outcomes, stating "…information technology must play a central role in the redesign of the health care system if a substantial improvement in quality is to be achieved" (IOM, 2001, p. 16).

There are many conversations and mandates around delivering high quality care, but understanding what constitutes quality, and what is meant by 'high quality', is essential to making effective changes in care delivery. Nine years before the Patient Protection Affordable Care Act ([ACA], 2010) was passed, The Institute of Medicine and Committee on Quality of Health Care in America (IOM, 2001), outlined a roadmap that succinctly listed essential achievements and quality aims to strive for in order to improve the health of Americans. The recommended initiatives (pp. 39–40) described care that is:

  1. Effective – Ensuring that care delivered is evidence based with proven efficacy

  2. Efficient – Minimizing waste of resources (equipment, supplies, ideas, and energy)

  3. Safe – Prevention of harm or injury from the healthcare delivered

  4. Timely –Harmful delays in care delivery are avoided

  5. Patient Centered – Patient's needs, preferences, and values are respected and upheld

  6. Equitable – No variance in the quality of care delivered to all

In the current healthcare climate, and within healthcare organizations, significant attention is placed on these quality aims. The Agency for Healthcare Research and Quality (AHRQ) cites the importance of these six domains of healthcare quality, and promotes the framework as a way for consumers to understand the meaning of quality (AHRQ, 2016). The American Hospital Association built the quality aims into its policy and advocacy agenda (American Hospital Association, 2017). If quality aims are actively integrated into direct clinical care, they possess the potential to greatly contribute to the timely delivery of safe and quality care, at good value, in a patient-centered way with the intent to mitigate health disparities, wherein all stakeholders win. Telehealth offers the opportunity to support achievement of quality aims, addressing barriers to care through innovative means and leveraging the proliferation of technology in an increasingly mobile-friendly and technology-centric population.