Is telemedicine the new normal? Evidence for the ongoing transformation of healthcare delivery since the onset of COVID-19 (Preprint)
Authors: Mandal Soumik , Wiesenfeld Batia , Mann Devin M. , Lawrence Katharine , Chunara Rumi , Testa Paul , Nov Oded 
Published: April 2022

BACKGROUND

The surge of telemedicine use during the early stages of the coronavirus-19 (COVID-19) pandemic has been well documented. However, scarce evidence considers the utilization of telemedicine in the subsequent period.

OBJECTIVE

This study aims to evaluate utilization patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in one large health system in New York City, and what this means for healthcare delivery.

METHODS

Retrospective electronic health record (EHR) data of patients between January 1st, 2020 and February 28th, 2022 were used to analyze and longitudinally track telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as comparing them to a pre-pandemic baseline (June to November 2019). Diagnosis codes to differentiate COVID-19 suspected visits from non-COVID-19 visits, as well as evaluating COVID-19 based telemedicine utilization over time, were compared to the total number of COVID-19 positive cases in the same geographic region (city-level).

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 utilization continued throughout the pandemic at a much higher level than the pre-pandemic baseline for both COVID-19 and non-COVID suspected visits, despite fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical activities. Utilization of telemedicine-based urgent care services for COVID-19 suspected visits increased in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. 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 increased use of telemedicine as a means of healthcare 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 utilization suggest that telemedicine-based healthcare delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and non-urgent care needs. These findings have implications for the healthcare 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 healthcare outcomes and experience.

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