TY  - JOUR
AU  - Nguyen, Oliver T
AU  - Alishahi Tabriz, Amir
AU  - Huo, Jinhai
AU  - Hanna, Karim
AU  - Shea, Christopher M
AU  - Turner, Kea
PY  - 2021
DA  - 2021/5/5
TI  - Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review
JO  - J Med Internet Res
SP  - e27531
VL  - 23
IS  - 5
KW  - telemedicine
KW  - telehealth
KW  - e-visits
KW  - electronic visits
KW  - digital care
KW  - outcome
KW  - delivery
KW  - review
KW  - access
KW  - utilization
KW  - cost
KW  - patient portal
KW  - eHealth
AB  - 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. 
SN  - 1438-8871
UR  - https://www.jmir.org/2021/5/e27531
UR  - https://doi.org/10.2196/27531
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33843592
DO  - 10.2196/27531
ID  - info:doi/10.2196/27531
ER  -