During a time that telehealth/telemedicine being reported on by virtually every media station, on March 12, the Consumer Technology Association (CTA) unveiled a set of principles for efficient and effective use of virtual care tools, addressing issues of consumer engagement, care quality, data privacy and more.
The guidelines identify 16 core principles that cover consumer/patient engagement, standards of care, quality, continuity of care, prescribing, and privacy and security. While these principles were developed before the COVID-19 outbreak, interest by health systems and consumers/patients in digital tools and virtual care will continue to grow.
Titled the Guiding Principles on Virtual Care, the proposals were developed by various virtual care companies affiliated with CTA, including Livongo, Doctor on Demand, Validic, and 98point6. In the official announcement, the CTA stated that the guidelines were not created with the current pandemic in mind. However, for the health care system to deal with clinician shortages, an aging population, the persistence of chronic diseases, and health inequities, technology-enabled solutions like virtual care are vital. The term virtual care used throughout the guideline is defined in the introduction as all products and services in the delivery of virtual care.
Consumers are open to the benefits of virtual primary care, which include removing the barriers to access that exist today and improving patient care. At Doctor On Demand, we believe there is an enormous opportunity to strengthen health care by connecting consumers to virtual primary care. – Ross Friedberg, Chief Legal & Business Affairs Officer, Doctor On Demand
One reason virtual care hasn’t taken off as predicted is that many patients are unaware the service is available to them. The CTA makes clear that the principles are voluntary considerations for consumers/patients, developers of virtual care tools, healthcare professionals who may use or benefit from the use of virtual care tools, and anyone with interest in the use of virtual care tools, such as third-party payors. Other applications include supporting the credibility of virtual care tools with consumers/patients and the broader healthcare industry.
Below we will outline the six categories that encompass the 16 guiding principles with a brief summary. To read the full CTA report, click here.
Note: the words consumers & patients are used interchangeably throughout this article.
Core Principle 1: Inform consumers and secondary users, such as providers of healthcare services, of how the virtual care tool is to be utilized to achieve specified outcomes and provide a seamless and efficient engagement.
Recommendations: For both patients/consumers and health systems implementing virtual care tools to their standard of care business model, there are countless digital technologies to consider. With that, CTA recommends virtual care tool developers follow best practices and inform consumers of the potential benefits and risks associated with using their tool. Developers should also align their clinical protocols with how best to utilize the virtual care tool to meet the intended outcome. An example of developers setting expectations and aligning clinical protocols may include prompting the patient to input certain information into the virtual care tool, to which the virtual care tool developer/provider will review in a certain amount of time.
Core Principle 2: Design the virtual care tool to allow users to ask questions about appropriate use and functionality.
Recommendations: As patients engage with virtual care services through virtual care tools, there will inherently continue to be questions that arise regarding the use and functionality of the virtual care tool. The CTA recommends that virtual care tools should develop a process to engage and assist users in understanding the appropriate use and functionality of the virtual care tool. They should also incorporate a strategy for managing consumer inquiries with published responses.
Core Principle 3: Design the virtual care tool to allow for universal access.
Recommendations: Consumers have varying needs when utilizing virtual care tools. The CTA recommends virtual care tool developers apply universal design principles and develop tools in light of guidance and standards regarding access and accommodation (i.e., advice and standards of the Americans with Disabilities Act and the accessibility advocacy community).
Core Principle 4: Build mechanisms to troubleshoot products when the technology fails
Recommendations: Virtual care tools, as with all technology, are subject to potential technical issues that may inhibit the patient’s ability to use a virtual care tool. When developing a contingency plan for technological failure, the CTA recommends developers should communicate to the patient what those plans are and inform them of any scheduled maintenance/expected changes or enhancements being made. Using telemedicine/telehealth as an example, a virtual care tool could provide for or prompt the creation of an alternative means of engagement between a healthcare provider and consumer, such as encouraging the consumer to give an alternative telephone number.
Standard of Care
Core Principle 5: Ensure that the virtual care tool works within, and use cases are described within, applicable best practice guidance from regulatory bodies and professional associations.
Recommendations: Depending on the virtual care tool being developed, various regulatory bodies may need to be precisely observed. With that, the CTA recommends virtual care tool developers and providers ensure virtual care tools work within established practice guidelines allowing virtual care providers to act within a consistent framework.
Core Principle 6: If a virtual care tool addresses a specific condition subject to a known standard of care, then the virtual care tool should be used consistent with or as an enhancement of the standard of care.
Recommendations: To be successfully adopted and to ensure the future of the organization, regulatory compliance is vital for virtual tools/digital health technologies. The CTA recommends that developers advise patients and providers of how the virtual care tool is consistent with or improves the applicable standard of care.
Core Principle 7: Consistent with best practices, virtual care tool developers should inform users of potential benefits and risks associated with using the virtual care tool based on input from appropriate healthcare professionals and review of current research, as needed. Particular care should be taken to inform users of potential risks if the use of the virtual care tool is intended to change an established standard of care, and if the outcomes of using the device are not yet well understood.
Recommendations: Almost every healthcare service provided comes with inherent risks and benefits. For a quick summary of this principle, the CTA recommends developers and providers inform consumers of the benefits and risks of utilizing the virtual care tools.
Core Principle 8: Understand what “quality” means with respect to (i) the use of the virtual care tool, (ii) the conditions addressed by the virtual care tool, and (iii) the impact of the virtual care tool on the consumers’ overall quality of life.
Recommendations: Digital tools that enable new methods and modalities to improve health care, enable lifestyle change, and create efficiencies are proliferating quickly. Before adopting any new digital health solution, healthcare organizations should first identify what specific needs should be addressed or improved, envision the intended outcome, and then look for a technology that is capable of delivering that solution.
The CTA recommends that developers create quality metrics in conjunction with healthcare providers, and assess the quality of the virtual care tool based on traditional and additional metrics (e.g., clinical outcomes, consumer engagement, technology use, peer review, and consumer feedback). Developers and health systems should separately and/or in-tandem track these quality metrics as a means to ensure utilization and that actual value has been created.
Core Principle 9: Continually address improvement in the implementation of the virtual care tool.
Recommendations: Healthcare organizations and virtual care organizations can start with the patient in mind. Establishing a feedback loop is a common strategy implemented. This process can help identify areas of opportunity from patients through satisfaction and/or experience survey responses.
Core Principle 10: Virtual care tool providers should be conscious of how addressing the quality of the virtual care tool, or its use may, in turn, address population-based outcomes.
Recommendations: In short, the CTA recommends that healthcare providers remain mindful of how addressing the quality of the virtual care tool and its use assists in managing and improving population-based health outcomes.
Core Principle 11: Virtual care tool developers and providers should ensure that the people that need to monitor quality (e.g., providers, executives, and compliance staff) have the appropriate access to the metrics to measure quality.
Recommendations: The CTA recommends developers and healthcare providers assure that all the people that will evaluate the quality of a virtual care tool and/or have access to the metrics by which quality is measured.
Continuity of Care
Core Principle 12: A virtual care tool should not interrupt or inhibit appropriate patient engagement within a comprehensive care plan, and where possible, should promote continuity of care.
Recommendations: The success of any implementation depends on engaging the right people. The newest technology can be very compelling. However, it may not be the most intuitive and could lead to misalignment within the organization’s strategic priorities. Ultimately, virtual care tools should promote continuity of care and should not interrupt or inhibit appropriate patient engagement within a comprehensive care plan. The CTA recommends patients can request, and virtual care providers can share a consumer’s information provided via a virtual care tool with the patient’s other healthcare providers…subject to patient consent.
Core Principle 13: Virtual care tool developers and providers should ensure consumers have access to their data vis-à-vis the virtual care tool and, to the extent allowable, direct who else may have access.
Recommendations: The CTA recommends virtual care tools and healthcare providers remain informed of and adhere to applicable legal requirements regarding a consumer’s access to his/her health information, and provisions regarding disclosure of health information.
Core Principle 14: Virtual care tools should not facilitate inappropriate prescribing and/or dispensing practices.
Recommendations: The laws applicable to prescribing prescription medications through virtual care tools continue to evolve. The CTA recommends virtual care providers continue to monitor and adhere to the dynamic regulatory requirements for defining and/or dispensing of prescription medications via virtual care tools.
Core Principle 15: Virtual care providers should collect complete and accurate information, whether from the consumer or from the consumer’s medical records (as available), to allow the virtual care provider to positively identify and appropriately prescribe medications to a consumer.
Recommendations: Recommended practices for core principle 15 suggest developers and healthcare providers build in reminders and notifications to assist the end-user in providing accurate and thorough information.
Privacy and Security
Core Principle 16: Virtual care tool developers should ensure that the use of virtual care tools complies with appropriate federal and state privacy and security laws.
Recommendations: For more information on principles relevant to the privacy of personal health information, check out an earlier CTA guideline titled Guiding Principles for the Privacy of Personal Health and Wellness Information. The report provides developers and health care organizations the procedures for protecting consumer data and maintaining consumer trust.
As the health care industry expands how people engage with health care services, there’s never been a more urgent need for innovative tech solutions…transparent and consensus-based deployment of virtual care tools will help us realize the long list of benefits – increased accessibility, improved quality of care and ultimately, better health outcomes for everyone, no matter where you live. – René Quashie, VP of digital health, CTA
Empowered patients are more satisfied patients. Reports show that patients with access to their own health data are far more likely to engage with the information in ways that improve the quality of care and their overall healthcare experience. The above principles laid out by the CTA are based on concepts, and best practices currently present and developing in the U.S. regarding the provision of virtual care and consumer protection. And while deemed voluntary, one of CTA’s main applications of the guiding principles is to educate patients, providers, payors and others about virtual care engagements to make informed decisions about the virtual care tools with which they choose to interact, and written and formatted in a way that the average person can easily understand.
With 147 million Americans living with chronic conditions today, and these conditions accounting for 90 percent of United States healthcare costs, it is more important than ever to offer consumer-first solutions that make it easier for people to stay healthy…in partnership with the CTA, Livongo is proud to take a leadership role ensuring that virtual health and care solutions provide the best possible experience while delivering key health outcomes and protecting the privacy of health consumers. – Amar Kendale, Chief Product Officer, Livongo
About Consumer Technology Association
As North America’s largest technology trade association, CTA® is the tech sector. CTA members are the world’s leading innovators – from startups to global brands – helping support more than 18 million American jobs. CTA owns and produces CES® – the largest, most influential tech event on the planet. Learn more at CTA.tech or follow on Twitter @CTAtech.