Evidence for Telemedicine's Ongoing Transformation of Health Care Delivery Since the Onset of COVID-19: Retrospective Observational Study

Abstract

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

Objective: This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery.

Methods: Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non-COVID-19 visits, as well as evaluating COVID-19-based telemedicine use over time, were compared to the total number of COVID-19-positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments.

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 use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non-COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. 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 the increased use of telemedicine as a means of health care 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 use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care 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 health care outcomes and experience.

Keywords: COVID-19; digital health; health care delivery; telemedicine; urgent care.

Figure 1

Trends in visits in telemedicine-based urgent care (VUC), nonurgent care (ambulatory), and in-person care. (a) Percentages of visit types, (b) total counts of visits per visit type, and (c) total counts for visit types per month. VUC: virtual urgent care.

Figure 2

Trends in visit types for suspected COVID-19 cases and confirmed COVID-19 cases in NYC. (a) Percentages of visit types, (b) total counts of visits by visit type, and (c) total counts for visit types per month. NYC: New York City; VUC: virtual urgent care.

Figure 3

Trends in visit types for non-COVID-19 suspected cases. (a) Percentages of visit types, (b) total counts of visit types, and (c) total counts for visit types per month. VUC: virtual urgent care.

Figure 4

Trends in telemedicine use by age group. (a) Stacked area graph of percentage of visits and (b) total counts of visits. NYC: New York City.

Figure 5

Trends in patients’ satisfaction with VUC visits (Q-Reviews) during the COVID-19 pandemic. VUC: virtual urgent care.