Consequences of Virtual Visit Implementation: Considerations for Supporting Collaborative Work

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Background: The use of virtual visits (i.e., phone- and video-based physician visits) has increased dramatically as a result of the COVID-19 pandemic. However, previous research indicates that implementation of this new model of care is difficult. Focusing on the work processes of patients and providers can provide important information about opportunities to optimize virtual visits so that patients and providers can experience better outcomes. Methods: We conducted a qualitative study to explore the perspectives of primary care physicians working at a large academic medical center (AMC) who used telemedicine, including virtual visits, during the COVID-19 pandemic. Semi-structured interviews with 20 physicians were conducted between July and August 2020. Interview questions asked about physicians’ challenges using telemedicine, the impacts of telemedicine on primary care work, and what helped them deliver care via telemedicine. All interviews were recorded, transcribed, coded, and rigorously analyzed using deductive thematic analysis guided by the Systems Engineering Initiative for Patient Safety 2.0 (SEIPS 2.0) framework to examine the impact of virtual visit implementation on work processes. Results: According to physicians, the use of virtual visits had positive and negative impacts on providers and patients. On one hand, virtual visits could (1) enable greater work-life balance, (2) allow for more flexibility as to when patient visits take place, (3) reduce some barriers to care and coordination of visits, (4) make patients feel comfortable interacting with their provider, (5) maintain patient-physician connections, and (6) get family members involved with the patient’s care. On the other hand, the use of virtual visits poses some challenges because they (1) necessitate coordination around “virtual rooming” and virtual visit appointments, (2) require some augmentation of virtual visits with in-person care, (3) may require a recalibration of patient expectations about virtual visits, (4) will need patients to access and use other tools to monitor their health and engage in care, (5) do not seamlessly integrate with interpreter services, and (6) infrequent interdisciplinary communication and consultations can hinder collaborative work. Conclusion: Virtual visits have been a critical element of the response to the COVID-19 pandemic, but our findings suggest the need to consider how we can retain the positive elements of this shift to virtual care while addressing issues that can reduce the negative consequences for providers and patients.