Barriers to Telemedicine Use: Qualitative Analysis of Provider Perspectives During the COVID-19 Pandemic.

BACKGROUND: Though telemedicine is a promising approach for removing barriers to care and improving access for patients, telemedicine use for many medical specialties has decreased from its peak during the acute COVID-19 public health crisis. Understanding the barriers and facilitators to the maintenance of web-based visits-one key component of telemedicine-is critical for ensuring the continuous availability of this service for patients. OBJECTIVE: The purpose of this study is to describe medical providers' perceived barriers and facilitators to the continued use of web-based visits to inform quality improvement efforts and promote sustainability. METHODS: We performed a qualitative content analysis of free-text responses from a survey of medical providers administered from February 5-14, 2021, at a large, midwestern academic institution, including all providers from medical professions that offered telemedicine (eg, physicians, residents or fellows, nurse practitioners, physicians assistants, or nurses) who completed at least 1 web-based visit from March 20, 2020, to February 14, 2021. The primary outcome was the experience of providing web-based visits, including barriers and facilitators to continued usage of web-based visits. Survey questions included 3 major domains: quality of care, technology, and satisfaction. Responses were coded using qualitative content analysis and further analyzed through a matrix analysis to understand the providers' perspectives and elucidate key barriers and facilitators of web-based visit usage. RESULTS: Of 2692 eligible providers, 1040 (38.6%) completed the survey, of whom 702 were providers from medical professions that offered telemedicine. These providers spanned 7 health care professions and 47 clinical departments. The most common professions represented were physicians (486/702, 46.7%), residents or fellows (85/702, 8.2%), and nurse practitioners (81/702, 7.8%), while the most common clinical departments were internal medicine (69/702, 6.6%), psychiatry (69/702, 6.6%), and physical medicine and rehabilitation (67/702, 6.4%). The following 4 overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. Though many providers saw web-based visits as a tool for improving care access, quality, and equity, others shared how appropriate selection of web-based visits, support (eg, patient training, home devices, and broadband access), and institutional and nationwide optimization (eg, relaxation of licensing requirements across state borders and reimbursement for phone-only modalities) were needed to sustain web-based visits. CONCLUSIONS: Our findings demonstrate key barriers to the maintenance of telemedicine services following the acute public health crisis. These findings can help prioritize the most impactful methods of sustaining and expanding telemedicine availability for patients who prefer this method of care delivery.

An Evaluation of eVisits at an Academic Medical Center.

An eVisit is a form of asynchronous telehealth whereby the patient submits an online request for medical advice and receives a written response from a health care provider. While thought to be an efficient way to resolve low-acuity medical issues, there is limited information on whether eVisits lead the avoidance of in-person care. We reviewed 8627 eVisits that occurred at our institution from July 2017 to March 2020 and found that 23.1% of eVisits required follow-up medical care within 14 days (22.6% with primary care physician, 0.3% with emergency department, 0.2% both). Our results indicate that eVisits are a feasible alternative to in-person care for low-complexity medical issues.

Assessing patient usability of video visits.

BACKGROUND: Telehealth is being adopted by health systems across the country and many barriers to the expansion of video visit programs have been identified. Our study focused on the usability of video visit technology by examining technical challenges faced by patients over the course of a video visit. METHODS: We conducted a survey of patients who received care from the Michigan Medicine video visit program from January 31, 2019 to July 31, 2019. The video visit program includes more than 1,300 visits a year across more than 30 specialties. Following the completion of their video visit, all patients were invited to participate in our online survey through the patient portal. The survey included questions on patient satisfaction, motivation and technical challenges. RESULTS: We received responses from 180 patients (response rate of 26%). Overall patient satisfaction was high; 90% of respondents agreed that their video visit experience was similar to that of in-person visits and 93.3% of respondents would recommend video visits. Despite this high satisfaction rate, 36 out of 180 (20.0%) respondents cited technical issues during their video visit: video issues (n=11), audio issues (n=5), video and audio issues (n=2), slow/dropped connection (n=7), initial set-up issues (n=4), long wait time (n=3), and other (n=4). CONCLUSIONS: While most patients report a high degree of satisfaction with their video visit, a meaningful subset of patients continue to experience technical challenges.