skip to main content
US FlagAn official website of the United States government
dot gov icon
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
https lock icon
Secure .gov websites use HTTPS
A lock ( lock ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Attention:

The NSF Public Access Repository (PAR) system and access will be unavailable from 11:00 PM ET on Thursday, June 12 until 2:00 AM ET on Friday, June 13 due to maintenance. We apologize for the inconvenience.


Title: COVID-19 transforms health care through telemedicine: Evidence from the field
Abstract This study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and nonurgent healthcare delivery from one large health system (NYU Langone Health) at the epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 102.4 daily to 801.6 daily. (683% increase) in urgent care after the system-wide expansion of virtual urgent care staff in response to COVID-19. Of all virtual visits post expansion, 56.2% and 17.6% urgent and nonurgent visits, respectively, were COVID-19–related. Telemedicine usage was highest by patients 20 to 44 years of age, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and nonurgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate.  more » « less
Award ID(s):
1928614
PAR ID:
10182881
Author(s) / Creator(s):
; ; ; ;
Date Published:
Journal Name:
Journal of the American Medical Informatics Association
Volume:
27
Issue:
7
ISSN:
1527-974X
Page Range / eLocation ID:
1132 to 1135
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. Background The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period. Objective This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery. Methods Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non–COVID-19 visits, as well as evaluating COVID-19–based telemedicine use over time, were compared to the total number of COVID-19–positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments. Results The emergence of COVID-19 prompted an early increase in the number of telemedicine visits across the urgent care and ambulatory care settings. This use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non–COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. Patients between 25 and 34 years of age were the largest users of telemedicine-based urgent care. Patient satisfaction with telemedicine-based urgent care remained high despite the rapid scaling of services to meet increased demand. Conclusions The trend of the increased use of telemedicine as a means of health care delivery relative to the pre–COVID-19 baseline has been maintained throughout the later pandemic periods despite fluctuating COVID-19 cases and the resumption of in-person care delivery. Overall satisfaction with telemedicine-based care is also high. The trends in telemedicine use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care delivery system, including practice leaders, insurers, and policymakers. Further investigation is needed to evaluate telemedicine adoption by key demographics, identify ongoing barriers to adoption, and explore the impacts of sustained use of telemedicine on health care outcomes and experience. 
    more » « less
  2. Abstract Objective Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage and treatment. Racial and ethnic disparities in health care have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19 . Materials and Methods Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis and COVID test results. Results Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95%CI:0.58-0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients. Discussion There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of Zip code were also significantly related to telemedicine use. Conclusion Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection; many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity. 
    more » « less
  3. Background: The implementation of telemedicine by healthcare providers was accelerated by the COVID‐19 pandemic and in most health systems has reached a lower but steady percentage of total visits. As health systems navigate the integration of telemedicine modalities into care delivery models, understanding the way each discipline can optimally utilize this technology has become increasingly important. The purpose of this study was to determine how specialists who perform surgical procedures as part of their practice want to implement telemedicine into their practice and when they believe it can be most effectively used within their work schedule. Methods: A survey regarding opinions about the use of telemedicine in the postoperative period was conducted in late 2019 prior to the onset of the COVID‐19 pandemic and re‐administered about one year later. The respondents were identified by department and division as physicians who perform at least some surgical procedures. All respondents practice as part of a single urban, academic, multispecialty group across the DC‐Maryland‐Virginia area. These healthcare professionals were asked about their experiences in telemedicine, willingness to incorporate telemedicine into their practice for post‐operative visits during their global surgical period, and their opinions on how accepting patients in general may be of telemedicine. The follow‐up survey provided an opportunity to examine how opinions evolved after having obligatory telehealth experience during the pandemic. Survey responses were analyzed and descriptive statistics are presented in this study. Results: A total of 77 unique respondents participated in the surveys, and we evaluated the responses of the 75 participants who had any telemedicine (TM) experience. Respondents were 74.7% male, 66.7% were aged 36‐55, and 46% had between 1‐10 years of practice experience while the rest reported >11 years of experience. Additionally, specialties included traditional surgical specialties, interventional radiology, ophthalmology, and dermatology. Of those who completed the second survey, 77.1% expressed that the COVID‐19 exposure to TM increased their interest in video TM follow‐ups for post‐operative visits. Respondents further believed that 93.6% of patients in general also express a similar sentiment. However, just 46.7% believe TM would increase their productivity even if the technological infrastructure was perfect. When asked about preferences for when they would perform TM visits, 40.0% said they would want to conduct them as a part of regular hours and 41.3% said they would want these visits during a dedicated time within working hours. If given the chance to offer TM outside regular hours or during the weekend, the majority of respondents was against it or unsure, 77.4% and 88.0%, respectively. Discussion: Although a majority of the respondents surveyed think patients are interested in telemedicine and are themselves interested in using telemedicine follow‐ups in the post‐surgical period, less than half believe that telemedicine would increase productivity. Also, there is great variability in preference for dedicated timeblocks for telemedicine versus integration into traditional clinic schedules. As health systems continue to iterate on optimal models to integrate telehealth into efficient care delivery, it is important to better understand how physicians performing surgical procedures consider the value proposition of telemedicine for post operative care. Further study is required to understand the barriers to utilizing telehealth and how its implementation could impact reimbursement, work hours, the future of work as well as patient access, patient convenience, and patient satisfaction. 
    more » « less
  4. Abstract The COVID-19 pandemic has boosted digital health utilization, raising concerns about increased physicians’ after-hours clinical work (work-outside-work”). The surge in patients’ digital messages and additional time spent on work-outside-work by telemedicine providers underscores the need to evaluate the connection between digital health utilization and physicians’ after-hours commitments. We examined the impact on physicians’ workload from two types of digital demands - patients’ messages requesting medical advice (PMARs) sent to physicians’ inbox (inbasket), and telemedicine. Our study included 1716 ambulatory-care physicians in New York City regularly practicing between November 2022 and March 2023. Regression analyses assessed primary and interaction effects of (PMARs) and telemedicine on work-outside-work. The study revealed a significant effect ofPMARs on physicians’ work-outside-work and that this relationship is moderated by physicians’ specialties. Non-primary care physicians or specialists experienced a more pronounced effect than their primary care peers. Analysis of their telemedicine load revealed that primary care physicians received fewerPMARs and spent less time in work-outside-work with more telemedicine. Specialists faced increasedPMARs and did more work-outside-work as telemedicine visits increased which could be due to the difference in patient panels. ReducingPMARvolumes and efficient inbasket management strategies needed to reduce physicians’ work-outside-work. Policymakers need to be cognizant of potential disruptions in physicians carefully balanced workload caused by the digital health services. 
    more » « less
  5. The Covid-19 pandemic has brought the rapid expansion of virtual services and automated patient care. While there is a growing body of research on how organizations can leverage algorithm-enabled systems to make patient decisions, attention to the synergistic combination of organizational resources surrounding the use of these systems in providing virtual patient care has been limited. More importantly, the enablement of new avenues for value-creation has been overlooked. This presentation report how health practitioners within virtual contexts successfully use algorithm-enabled patients care systems based on interviews with health professionals working in a Virtual Intensive Care Unit. 
    more » « less