The Agency for Healthcare Research and Quality "Safety Program for Telemedicine: Improving the Diagnostic Process" is a free quality improvement program designed to help practices improve the cancer diagnostic process. It is led by NORC at the University of Chicago, Johns Hopkins University and Baylor College of Medicine.

Cancer diagnosis is a complex, multistep process that takes place over time and often involves several specialties. Patients all too often fall through the cracks, resulting in a delayed or missed diagnosis. Telemedicine adds another layer of complexity and can serve as both a barrier and facilitator to the diagnostic process.

The program aims to improve the cancer diagnostic process in telemedicine-enabled primary care settings by strengthening safety culture and helping practices to close the loop on care transitions and other vulnerable processes along the cancer diagnostic pathway.

The AHRQ aims to target key points throughout the diagnostic process where there are opportunities to reduce delays and improve care coordination.

Because the program currently is recruiting primary care practices, including OB/GYNs, and is slated to start in June, Healthcare IT News sat down with two of its investigators to get a deeper look.

Dr. Hardeep Singh is principal investigator. He is professor of medicine at Baylor College of Medicine, staff physician at Michael E. DeBakey Department of Veterans Affairs Medical Center, and chief of health policy, quality and informatics program at the Houston VA Center for Innovation in Quality, Effectiveness and Safety.

He codeveloped national VA policy on diagnostic test results communication, cochaired the National Quality Forum committee on health information technology safety measurement recommendations, and codeveloped ONC SAFER Guides, providing national recommendations for safe electronic health record use.

Andrea Bradford is a co-investigator. She is a team scientist, licensed psychologist and associate professor at Baylor College of Medicine. Her main interest is developing programs and tools that address gaps in health services and healthcare quality.

In addition to her scientific roles, Bradford has more than a decade of experience as a clinical psychologist embedded in medical specialty settings. She has established two novel integrated health psychology services at the University of Texas MD Anderson Cancer Center (2010–2016) and Baylor College of Medicine (2016–present).

Q. What is the status of the "AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process."

Singh: We currently are recruiting primary care, OB/GYN, community-based health and urgent care clinics for the program. Over 18 months, participants will gain practical knowledge and skills to address several vulnerabilities in the diagnostic process, such as referrals, follow-up of abnormal test results and managing diagnostic uncertainty.

Through a series of brief, approximately 30-minute interactive webinars, clinicians and practice staff will learn skills and strategies they can pilot in their practices. The program also includes supports to implement these strategies, including one-on-one consultation with a quality improvement adviser and learning collaborative sessions with other participating practices.

While the program is specific to cancer, many of the concepts are transferable to diagnosis and care coordination of other diseases.

Q. What should CIOs, CMIOs and other health IT leaders at healthcare provider organizations know about this effort?

Bradford: This program will help practices close the loop at critical points in the diagnostic process by leveraging technologies already in place and deploying IT in a way that maximizes impact in a hybrid – both telemedicine and in-person – environment.

It is free to practices, engages clinicians and staff, and provides expert consultation. Most importantly, it can help to improve patient safety and prevent harm.

Through the program, practices also will build skills to learn from their own data. Support will be provided for building capacity and infrastructure for data collection, reporting, analysis and feedback. These data will help practices pinpoint gaps in current processes that can be targeted for improvement and to assess the impact of any changes.

The program does not require specific electronic health record platforms, configurations or reporting, will not collect any protected health information, and will not identify any individual patients, clinicians, practices or health systems.

Q. What should clinicians engaging in telemedicine know about this effort?

Singh: This is an exciting opportunity for clinicians to expand their technical knowledge and improve care quality and patient safety while earning continuing medical education units, continuing education units, and American Board of Internal Medicine Maintenance of Certification points, as eligible.

Recognizing that hybrid care is now common, this program will help clinicians understand how to optimize the application of telemedicine during the diagnostic process.

We recognize clinicians have busy schedules and competing demands, so the program focuses on solutions that practices can easily implement and offers webinars and co-learning opportunities in multiple formats and time points.

Webinars are brief (30 minutes) and will be made available to view asynchronously. The team will only need to spend about two hours per month on the program – including attending webinars, reviewing program materials and meeting with their practice team and quality improvement adviser. One staff member will allocate an additional hour per month to complete data collection forms.

Another benefit of this program is that it can engage all types of practice staff. Practice teams can include clinicians, residents and fellows; midlevel providers such as physician assistants and nurse practitioners; clinical support staff, including nurses and medical assistants; and, if available, schedulers and practice staff who perform care-coordination or navigation.

The program provides flexibility for staff to learn in a way that fits into their schedules and preferred learning mode by offering both live and recorded webinars, as well as online access to presentations, facilitator guides, and accompanying learning tools and resources.

Our program staff is dedicated to helping practices succeed and will work closely with participating practices to troubleshoot any issues should they arise.

Q. What would be the ultimate achievement of this effort?

Bradford: We hope that participating practices will implement enhanced diagnostic processes that result in fewer patients with delayed or missed cancer diagnoses. While the program focuses on cancer, the strategies learned in this program are transferable and may also contribute to improved diagnostic processes of other conditions.

Through webinars, coaching and collaborative peer learning, we anticipate participants will learn best practices for closing the loop at critical points in the diagnostic process for cancer in the telemedicine environment, be better prepared to serve an increasing patient volume over telemedicine, and emerge with skills that improve patient safety, prevent harm and enhance care delivery quality.

We are very excited about this program and strongly encourage practices to consider joining. The deadline to apply is May 25, 2023. You can contact us at safetyprogram4telemedicine@norc.org.

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