Table 2.

Steps to Advance Understanding of Telemedicine Impact on Patient Safety

Key recommendations	Recommendations for each stakeholder
Systematically measure patient safety outcomes and increase reporting of safety incidents, with a focus on those most likely increased by telemedicine	Researchers - Explicitly include safety outcomes, particularly those identified in existing ambulatory patient safety literature - Include easily measured outcomes extracted from the electronic health record
	Healthcare systems - Improve infrastructure to ease clinician use and access to incident reporting systems - Increase patient engagement in safety evaluations by:   - Increasing opportunities for patients to report safety incidents   - Including patients in quality and safety committees
Identify the patients and clinical scenarios with the greatest risk of unsafe telemedicine care	Researchers - Identify patient characteristics that may increase risk for safety incidents - Evaluate clinical scenarios when telemedicine can facilitate safer care, including variations in chief complaints, visit purpose, clinician specialty, or type of telemedicine - Focus on comparative effectiveness evaluations (e.g., is in-person care an appropriate comparison?)
	Healthcare systems - Disseminate and describe telemedicine implementation strategies to facilitate research that explores the issues above - Partner with evaluators to ensure rigorous, real-world evaluations
Identify and support best practices* to ensure equal access to safe telemedicine care	Research funders (identify best practices) - Fund evidence generation to identify best practices
	Healthcare systems (support best practices) - Proactively support audio-visual encounters for as many patients as possible - Develop strategies to support patients that may have challenges accessing video telemedicine encounters, such as older patients or patients with language barriers or limited digital literacy21
	Policy makers (support best practices) - Increase funding for programs that improve digital infrastructure (broadband) and digital access (low-cost broadband and devices)
	Healthcare payors (support best practices) - Provide reimbursement to support all patients in accessing telemedicine care - Recognize additional resources are needed by clinicians that serve patients with challenges accessing telemedicine - Reimburse for remote monitoring tools and home diagnostic procedures

*These recommendations are focused on video-based telemedicine and access to remote clinical data as best practices and meant to illustrate how best practices should be supported by multiple stakeholders