Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study

Gmunder, Kristin N; Ruiz, Jose W.; Franceschi, Dido; Suarez, Maritza

doi:10.2196/27977

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…Within the Alabama Medicaid population, telehealth services have proven to be extremely viable and have withstood the large-scale availability of vaccines to continue to be a modality of choice for health care in both rural and urban areas. Telemedicine is likely to continue to play an integral role in health care, and as a first step toward increasing the use of telemedicine, health care systems should focus on improving patient portal usage for better access to telemedicine services [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends

Xu¹,

Hudnall²,

Zhao³

et al. 2022

J Med Internet Res

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Background The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic–related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services. Objective Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities. Methods We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination. Results The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination. Conclusions The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.

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Section: Discussionmentioning

confidence: 99%

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends

Xu¹,

Hudnall²,

Zhao³

et al. 2022

J Med Internet Res

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“…[47][48][49][50][51][52][53][54] • The literature describes a wide variety of clinician-facing, sociotechnical implementation strategies, including securing and organizing human resources (e.g., clinician champions); developing guidelines, standard scripts, and best practices; offering trainings and clearly communicating evolving processes and resources; and leveraging technological resources. [47][48][49][50][51][52][53]55 • The patient-facing initiatives reported in the literature are limited to technological training and support, with an emphasis on mitigating the risk of digital health disparities. [47][48][49][50]52,[55][56][57][58][59][60][61][62] Developing and deploying portal tools to respond to COVID-19…”

Section: Developing Deploying and Evaluating New Care Processesmentioning

confidence: 99%

“…[47][48][49][50][51][52][53]55 • The patient-facing initiatives reported in the literature are limited to technological training and support, with an emphasis on mitigating the risk of digital health disparities. [47][48][49][50]52,[55][56][57][58][59][60][61][62] Developing and deploying portal tools to respond to COVID-19…”

Section: Developing Deploying and Evaluating New Care Processesmentioning

confidence: 99%

“…facing strategies. Successful implementation or scaling-up of virtual care was a sociotechnical endeavor requiring multiple initiatives, including securing and organizing human resources (e.g., clinician champions, front-line staff working groups) [47][48][49][50]52,53,55 ; developing an optimization methodology (e.g., using data-driven processes to map out workflows, identify areas for improvement, and design and evaluate interventions) and/or using an established implementation science framework 48,50 ; clearly defining the roles and responsibilities for different members of the clinical team 49,51,53 ; developing guidelines, standard scripts, and best practices [48][49][50]52,53,55 ; offering regular trainings and educational materials [47][48][49][50]52,53 ; developing a robust communication strategy for disseminating evolving processes and resources 47,48,52,55 ; and leveraging technological resources to support humans where possible (e.g., automating processes). 49,51,53 While the literature generally shows that patients are receptive to virtual health care services, 48,58,60,61 patients may also need support to adopt virtual care.…”

Section: Developing Deploying and Evaluating New Care Processesmentioning

confidence: 99%

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The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Reynolds,

Cobb,

Steitz

et al. 2023

Appl Clin Inform

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Background and Objective Recent external factors—the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic—have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. Methods To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. Results Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). Conclusion Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.

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“…In behavioral health settings, patient portals have been shown to increase a sense of patient autonomy, improve patient activation, and decrease administrative inefficiencies [ 17 , 18 ]. A recent study in a large health system across multiple specialties has also demonstrated patient portal activation is associated with increased patient ability to complete telemedicine visits [ 19 ]. Furthermore, video-based appointments performed directly through electronic medical record (EMR)–based patient portals such as MyChart provide an additional layer of security compared to separate virtual platforms such as Doximity or Skype [ 15 ] and have the advantage of closer integration with the patient’s medical record, which may help with documentation and billing [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study

Yue¹,

Mail²,

DiSalvo³

et al. 2022

JMIR Form Res

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Background Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to use telepsychiatry services. Objective As an extension to a clinic’s outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal–based video visits or telephone-only visits and to identify the demographic variables associated with their preference. Methods Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. Results A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. Conclusions Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

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Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study

Cited by 8 publications

References 22 publications

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study

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