Everyday use of technology to connect individuals near and far is now widespread; a trend which has also transposed into the healthcare industry. The COVID-19 pandemic led to a surge in the urgent need to connect health and care providers to their patients through remote appointments, and a need to address the ongoing concerns about how delivery of care would be maintained. Typically, doctors and other health care providers care for their patients in person at a facility such as a medical office, clinic, or hospital, but with the technology advancement of using computers, smartphones, and other new digital technologies, medical professionals can now diagnose, treat, and oversee their patients' care virtually. This blog outlines how health and care providers can leverage standards, such as ISO 13131:2021, for developing and establishing telemedicine and telehealth processes, with the ultimate goal of improved availability and quality care for patients.

In May 2021, the International Organization for Standardization’s Technical Committee on health informatics (TC215) developed a new guideline ¬– ISO 13131: 2021 . This guideline standard outlines processes that can be implemented to analyse risks to patient data security, and the quality and safety in the delivery of continuity of care, when providers employ telehealth services with their patients. Telehealth is defined as the delivery of health care services at a distance through the use of technology. It can include everything from conducting medical visits over the computer, to monitoring patients' vital signs remotely. Telehealth can be delivered in one of three ways:

• Synchronous – when the doctor communicates with the patient in real time via computer or telephone
• Asynchronous – when data, images, or messages are recorded to share with the doctor later
• Remote patient monitoring – when measurements such as weight or blood pressure are sent to the health care provider.

Healthcare technology is rapidly becoming a fundamental part of the delivery of care, as it enables hospitals, physicians, payers and employer groups to be cost efficient, while improving the availability and quality of care. Virtual care, including virtual clinics and remote interactions with doctors, has been crucial for screening and treating COVID-19 cases from afar. Additionally, the ability to use remote care services has also enabled routine or elective care to continue in an otherwise risky and complicated time of the pandemic. According to a survey from the Medical Group Management Association, 97% of healthcare leaders have expanded telehealth access since the pandemic – showing that telehealth services is a trend that has been and will likely continue to be fully adopted and embraced.

Health and care providers can face challenges in managing new technology, patient data security, as well as the need to reach patients globally with resource constraints around expertise. As the number of patients with chronic conditions rises, in part due to an ageing population, health and care providers have been forced to adopt with technology-enabled ways of diagnosing, monitoring, and treating patients while maintaining the quality of healthcare services. Additionally, patients must be open to receiving such methods of remote care. Almost three-quarters of population surveyed said the pandemic has made them more eager to try virtual care. And one in four people aged 50+ said they'd had a virtual health care visit during the first three months of the pandemic, up from just four percent of older adults who'd had a remote visit the previous year.

But how do we measure the success of telehealth services?

Quality of health and care services is measured through an assessment of whether provided services meet the needs of patients. The novelty of telehealth services included in this measurement of quality of care, is an important and necessary development for the industry.  These services include, but are not limited to, offering treatments which maintain or improve quality of life, a cure for illnesses where possible and extending life expectancy. Researchers use a variety of measures to assess quality such as disease improvement after medical diagnosis, a decrease in risk factors following preventive care, or a survey of health indicators in a population who access care. As outlined in the standard, health informatics is a way of assessing the quality of care through technology and one of the fastest growing areas in health. It involves the intelligent use of information and technology to provide better care for patients, even if deployed remotely. The ISO 13131 guidelines enable health and care providers to develop a structured management system in order to plan for and effectively evaluate and assess the extent of quality of care provided to the patients. 

The release of ISO 13131:2021 in 2021 provides direction with a focus on the quality and risk management methods required to define guidelines for distinct remote health and care services. ISO 13131:2021 belongs to a class of standards that provides flexible, general guidelines that support innovation in healthcare.

Most countries have national safety and quality health service standards, but few have advanced to encompass how to govern remote delivery of health and care services – further emphasizing the role of this important standard. ISO 13131:2021:

• Ensures minimum standards of security, safety and quality are met through a quality assurance process that verifies relevant governance and systems in place
• Enables health and care service organisations to realise technological expansion goals through a quality improvement mechanism
• Ensures integrated systems of governance actively manage patient safety and quality risks
• Provides advice to support care provided by the clinical workforce which is guided by current best practice
• Helps to ensure the clinical workforce have the right qualifications, skills and approach to provide telehealth health and care through performance measurement and skills management
• Provides guidance on incident and complaints management for patient safety and quality, when services are delivered remotely
• Provides patient rights and engagement benchmarks to ensure patient rights are respected and engagement in care is supported

While ISO 13131:2021 offers recommendations on standards that can be used to assist the development of telehealth services, the responsibility for developing appropriate guidelines for each health service remains with each organisation. Further research will be required to assess the role of guidelines and standards in enabling a successful transition from healthcare delivered face-to-face to healthcare delivered through telehealth. Transitioning from face to-face delivery of health services to telehealth will require a shift in the way care providers conceive and manage safety and quality.

1. Office for National Statistics. Internet access – households and individuals, Great Britain: 2018. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2018. Last accessed November 2021
2. Bokolo AJ. Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic. Ir J Med Sci. 2021 Feb;190(1):1-10.
3. Price WN 2nd, Cohen IG. Privacy in the age of medical big data. Nat Med. 2019;25(1):37-43.
4. Medical Group Management Association – COVID-19 took significant toll on medical practices’ ancillary services. Available at: https://www.mgma.com/data/data-stories/covid-19-took-significant-toll-on-medical-practice. Last accessed November 2021.
5. Harvard Health Publishing. Telehealth: The advantages and disadvantages, 2020. Available at: https://www.health.harvard.edu/staying-healthy/telehealth-the-advantages-and-disadvantages. Last accessed November 2021.