PERFORMANCE IMPROVEMENT IN TELEMEDICINE - THE ESSENTIAL ELEMENTS

Performance improvement activities in telemedicine may be placed into five categories. [1] Licensing and credentialing. Telemedicine overcom es geographical boundaries, but its reach is constrained by state laws on licensing. Some states require a state license, whereas others gra nt ''consultation exemptions'' for out-of-state physicians. Simple ren ewable licenses do not guarantee quality. Potential solutions include a national telemedicine license or license reciprocity laws for teleme dicine. (2) Data security and privacy. Telemedicine technology raises some security concerns. Differences in reporting requirements among st ates complicate the issue of privacy. Storage of telemedicine consulta tion records may help physicians document care decisions for risk mana gement, but conventional long-term storage may not be feasible because of cost constraints and may not be required to document the encounter appropriately. (3) Informed consent. Potential failures in security a nd transmission are new, and should be communicated to the patient. (4 ) Peer review. Peer review findings encourage thorough, accurate, and legible documentation. Results should be recorded by provider and must be available during the recredentialing process. (5) Tailored perform ance improvement initiatives. By using established principles and tech niques, performance improvement initiatives can gather, analyze, and c ommunicate information about the cost-effectiveness of telemedicine. T hese performance improvement efforts are the heart of quality manageme nt and are critical to the justification of telemedicine. Walter Reed Telemedicine has put into effect a performance improvement plan in acc ordance with this outline. This article describes the plan and suggest s it as a model for other telemedicine programs.