Future of Teleoncology: Trends and Disparities in Telehealth and Secure Message Utilization in the COVID-19 Era

Abstract

Purpose: The COVID-19 pandemic created an imperative to re-examine the role of telehealth in oncology. We studied trends and disparities in utilization of telehealth (video and telephone visits) and secure messaging (SM; ie, e-mail via portal/app), before and during the pandemic.

Methods: Retrospective cohort study of hematology/oncology patient visits (telephone/video/office) and SM between January 1, 2019, and September 30, 2020, at Kaiser Permanente Northern California.

Results: Among 334,666 visits and 1,161,239 SM, monthly average office visits decreased from 10,562 prepandemic to 1,769 during pandemic, telephone visits increased from 5,114 to 8,663, and video visits increased from 40 to 4,666. Monthly average SM increased from 50,788 to 64,315 since the pandemic began. Video visits were a significantly higher fraction of all visits (P < .01) in (1) younger patients (Generation Z 48%, Millennials 46%; Generation X 40%; Baby Boomers 34.4%; Silent Generation 24.5%); (2) patients with commercial insurance (39%) compared with Medicaid (32.7%) or Medicare (28.1%); (3) English speakers (33.7%) compared with those requiring an interpreter (24.5%); (4) patients who are Asian (35%) and non-Hispanic White (33.7%) compared with Black (30.1%) and Hispanic White (27.5%); (5) married/domestic partner patients (35%) compared with single/divorced/widowed (29.9%); (6) Charlson comorbidity index ≤ 3 (36.2%) compared with > 3 (31.3%); and (7) males (34.6%) compared with females (32.3%). Similar statistically significant SM utilization patterns were also seen.

Conclusion: In the pandemic era, hematology/oncology telehealth and SM use rapidly increased in a manner that is feasible and sustained. Possible disparities existed in video visit and SM use by age, insurance plan, language, race, ethnicity, marital status, comorbidities, and sex.

FIG 1.

Proportions and absolute numbers of office, telephone, and video visits between March 19, 2021, and September 30, 2021, by (A) age group, (B) race and ethnicity, (C) insurance type, (D) sex, (E) language/require interpreter, (F) Charlson comorbidity index, (G) marital status, (H) driving distance to clinic, and (I) clinic city population density. Missing/unknown values, when present, were grouped with other categories as described in the figure. Comparisons were made using Pearson's χ² statistic. P < .01 for all comparisons.

FIG 2.

Total number of secure messages per patient between March 19, 2021, and September 30, 2021, by (A) age group, (B) race and ethnicity, (C) insurance type, (D) sex, (E) Charlson comorbidity index, (F) language/require interpreter, (G) marital status, (H) driving distance to clinic, and (I) clinic city population density. Missing/unknown values, when present, were grouped with other categories as described in the figure. All comparisons were made using Mann-Whitney U test. P < .01 for all comparisons. AA, African American; PI, Pacific Islander.

FIG 3.

Trends in (A) overall visits, new consultations, (B) utilization of office and telehealth visits, as well as (C) secure messages from January 2019 to September 2020, before and since the COVID-19 pandemic.