Cosmos Study

Telehealth Utilization Higher Than Pre-Pandemic Levels, but Down from Pandemic Highs

November 21, 2023

Team A:Kersten Bartelt, RNAlex Piff

Team B:Steve Allen, MDEric Barkley

Key Findings

While telehealth usage has declined since the initial peak early in the pandemic, it is still used much more broadly than before the pandemic.
In mental health, infectious disease, OB, and transplant departments, the proportion of encounters that used telehealth in the third quarter of 2023 is higher than other specialties.

Telehealth is used for a wide range of acute and chronic medical conditions in both specialties and primary care. It allows healthcare providers to reach underserved populations, such as those in rural areas.¹Telehealth became a necessary means of healthcare delivery during the peak of the COVID-19 pandemic. We previously reported increased rates of telehealth early in the pandemic.² In this study, we are seeking to understand how telehealth use now compares to telehealth use before the pandemic.

We evaluated 475,229,277 telehealth and in person encounters between Q2 2019 and Q3 2023. Pre-pandemic, across all specialties, telehealth was a low proportion of visits, averaging less than 1% of visits in the last three quarters of 2019. In Q2 2020, the proportion of telehealth visits peaked across all specialties, with the highest rates in mental health (65.5%), endocrinology (55.5%), geriatrics (55.2%), transplant (52.2%), and GI (51.5%). Across all specialties, we saw another, smaller spike in telehealth in Q1 2022 when the omicron variant contributed to another spike in COVID cases. As of Q3 2023, the specialties with the highest rates of telehealth utilization were mental health (37%), infectious disease (11%), OB (10%), and transplant (10%). The specialties with less than 1% of visits occurring through telehealth in Q3 2023 include ophthalmology, podiatry, and wound care. This likely reflects the hands-on nature of the care provided by these specialties.

Figure 1

Percentage of Encounters Conducted Using Telehealth

Figure 1. The proportion of visits in each specialty that are completed using telehealth sorted by average proportion of telehealth encounters over the study period.

These data come from Cosmos, a collaboration of 222 Epic health systems representing over 220 million patient records from 1,272 hospitals and more than 27,200 clinics from all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.   

References

Barbosa, W., Zhou, K., Waddell, E., Myers, T., & Dorsey, E. R. (2021). Improving access to care: Telemedicine across medical domains. Annual Review of Public Health, 42(1), 463–481. https://doi.org/10.1146/annurev-publhealth-090519-093711
Expansion of Telehealth During COVID-19 Pandemic. (2020, May 5). Epicresearch.org. https://epicresearch.org/articles/expansion-of-telehealth-during-covid-19-pandemic/