Abstract
BackgroundElectronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear.ObjectiveTo address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs.MethodsWe conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impacts on clinical and health care delivery outcomes.ResultsOut of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs.ConclusionsOverall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.
Highlights
Telemedicine—or the delivery of health care at a distance—can improve health care access and quality while reducing health care utilization and costs [1]
Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions
Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions
Summary
Telemedicine—or the delivery of health care at a distance—can improve health care access and quality while reducing health care utilization and costs [1]. Studies have demonstrated that telemedicine may achieve comparable clinical outcomes to in-person care across a variety of conditions, such as stroke care [5], heart failure [6,7], hepatitis C [8], and diabetes [8]. Telemedicine can reduce the utilization of in-person care and reduce health care costs [3,4,9]. Studies have shown that the impact of telemedicine on health care delivery and patient outcomes varies across telemedicine types. Some forms of telemedicine, such as telestroke [12,13,14], have a strong evidence base while other forms of telemedicine, such as electronic visits (e-visits), are understudied. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear
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