Background The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective This study aimed to assess health system–level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system–level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). Conclusions Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine.

BACKGROUND COVID-19 prompted safety-net healthcare systems to rapidly implement telemedicine services with little prior experience. OBJECTIVE To assess health system-level factors and their impact on telephone and video visit use to inform future telemedicine practices. METHODS We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 2020-July 14 2020. We conducted bivariate analyses assessing healthcare system-level factors associated with 1) Regular phone adoption (4 or more visits on average per half-day); and 2) video visit adoption (at least 1 video visit on average per half-day). RESULTS We collected 311 responses from 643 eligible clinicians, for a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (N=108) primary/urgent care, 35.1% (N=109) medical, and 7.4% (N=23) surgical specialties. Our sample included 178 (57.2%) telephone adopters and 81 (26.05%) video adopters. Primary/urgent care had the highest proportion of telephone adoption (84.3%; vs. 50.4% medical, 37.5% surgical, P <0.001); medical specialties had the highest proportion of video adoption (39.1%; vs. 14.8% primary care, 12.5% % surgical, P <0.001). Among telephone adopters, 72.2% utilized personal devices for telemedicine (versus 59.0% non-regular telephone adopters, P=0.04). Video non-adopters requested more training in technical aspects than adopters (49.6% vs. 27.2%, P =0.0005). CONCLUSIONS Clinical specialty type, personal device use, and desire for technical training were major factors driving telephone and video visit adoption among safety-net clinicians. Department-level support, distribution of devices, and clinician trainings are priorities for safety-net systems.