Understanding Telemedicine's “New Normal”: Variations in Telemedicine Use by Specialty Line and Patient Demographics

TLDR

Variation in telemedicine adoption and modality highlights the need to balance patient‑ and clinic‑level factors to promote sustainable, equitable integration. The study aimed to examine how telemedicine use varied by specialty line and patient demographics after the pandemic peak when in‑person visits resumed to prepandemic levels. The authors analyzed aggregated encounter data from six service lines over three periods and calculated risk ratios to compare telemedicine versus in‑person use and modality by race, age, sex, and insurance. Telemedicine adoption varied widely by specialty (3.2%–98.3%) and was lower among African American and male patients, with African American, publicly insured, and older patients less likely to use video; overall visit volume returned to prepandemic levels and demographic differences were negligible.

Abstract

Background:Our objective was to examine the variation in telemedicine adoption by specialty line and patient demographic characteristics after the initial peak period of the coronavirus disease 2019 pandemic when in-person visits had resumed and visit volume returned to prepandemic levels. Materials and Methods:Aggregated encounter data were extracted for six service lines (dermatology, psychiatry, endocrinology, cardiology, orthopedics, and nonurgent primary care) in an integrated health system across three time periods: July 1 to September 30, 2019 (n = 239,803), July 1 to September 30, 2020 (n = 245,648), and December 29, 2019 to October 3, 2020 (n = 624,886). Risk ratios were calculated to assess the relative use of telemedicine compared with in-person encounters and telemedicine modality (i.e., synchronous audio/video vs. audio-only telephone) by patient race, age, sex, and insurance type. Results:By June 2020, total visit volume returned to prepandemic levels. Differences in patient demographics between July 1 to September 30, 2020 and the previous year's baseline were negligible. Telemedicine adoption varied by medical specialty, from 3.2% (dermatology) to 98.3% (psychiatry) of visits. African American and male patients were less likely to use telemedicine (telephone or video) compared with white and female patients. Among telemedicine encounters, African American, publicly insured, and older patients were less likely to use video compared with white, commercially insured, and younger patients. Discussion:Variation in telemedicine adoption and modality underscores the importance of balancing patient- and clinic-level implementation factors to promote sustainable, equitable telemedicine integration. Conclusion:Understanding current trends in the “new normal” of telemedicine provides valuable insights into future implementation and financing.