Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

Abstract

Background Electronic 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. Objective To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. Methods We 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. Results Out 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. Conclusions 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. 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.

Attitudes, Barriers, and Concerns Regarding Telemedicine Among Swedish Primary Care Physicians: A Qualitative Study

“…10 Regarding clinical outcomes, evidence indicates that telemedicine is at least as effective as face-to-face care across several mediums, diseases, and medical specialties including primary care. [11][12][13][14][15] CDSS have been found to positively affect practitioner performance. 16 Computerbased medical histories have been shown to be clinically relevant.…”

“…17 However, for all areas, evidence of higher quality is needed. [11][12][13][14][15][16][17] For artificial intelligence in primary care, clinical applications and research are under rapid development but also raise concerns. [18][19][20][21] New digital environments can be challenging for patients and caregivers alike, requiring continuous learning and adjustment.…”

Evaluating the Quality of Asynchronous Versus Synchronous Virtual Care in Patients With Erectile Dysfunction: Retrospective Cohort Study

“…Though the pandemic led to regulatory revisions permitting reimbursement for asynchronous care [ 8 ], policymakers and practitioners have maintained reservations, particularly in direct-to-consumer (DTC) scenarios where care is commonly delivered asynchronously but patients and providers do not have a preexisting relationship [ 2 , 9 ]. This hesitation is justified given the limited evidence on whether telemedicine can lead to inappropriate prescribing and increased risk of failing to identify factors that might contribute to increased side effects [ 10 ].…”

“…However, another study comparing these modalities found that asynchronous care might create conditions that could negatively impact patient safety: providers adopted different prescribing behaviors depending on the modality of treatment for otherwise similar patients [ 13 ]. A recent literature review identified only 19 studies that quantitatively evaluated e-visits and concluded that while they appeared to result in similar health outcomes as compared to in-person care, evidence on quality outcomes is mixed, and there were no included studies comparing them to telephone or video visits [ 8 ].…”

Improvement and Evaluation of the TOPCOP Taxonomy of Patient Portals: Taxonomy-Evaluation-Delphi (TED) Approach

“…A patient portal is an internet-based application combining knowledge and software tools [ 18 , 19 ] that allow patients to have autonomous access to their electronic health record (EHR) anywhere at any time [ 20 , 21 ]. Besides its core function of providing EHR access [ 22 ], the features of a patient portal range from viewing visit notes, requesting medication refills, appointment scheduling, access to test and lab results, secure messaging with the health provider, e-visits, or reporting patient-generated health data [ 17 , 23 - 26 ]. Patient portals are used in different organizational settings such as independent physician practices and hospitals, group practices, or large, integrated health care delivery organizations [ 27 - 29 ].…”