The Telemedicine Experience in Primary Care Practices in the United States: Insights From Practice Leaders

Grace Rabinowitz; Logan D Cho; Natalie C Benda; Crispin Goytia; Katerina Andreadis; Jenny J Lin; Carol Horowitz; Rainu Kaushal; Jessica S Ancker; Jashvant Poeran

doi:10.1370/afm.2967

The Telemedicine Experience in Primary Care Practices in the United States: Insights From Practice Leaders

Ann Fam Med. 2023 May-Jun;21(3):207-212. doi: 10.1370/afm.2967.

Authors

Affiliations

¹ Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
² Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
³ Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
⁵ Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
⁶ Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York jashvant.poeran@mountsinai.org.
⁷ Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
⁸ Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York.

^# Contributed equally.

Abstract

Purpose: The need to rapidly implement telemedicine in primary care during the coronavirus disease 2019 (COVID-19) pandemic was addressed differently by various practices. Using qualitative data from semistructured interviews with primary care practice leaders, we aimed to report commonly shared experiences and unique perspectives regarding telemedicine implementation and evolution/maturation since March 2020.

Methods: We administered a semistructured, 25-minute, virtual interview with 25 primary care practice leaders from 2 health systems in 2 states (New York and Florida) included in PCORnet, the Patient-Centered Outcomes Research Institute clinical research network. Questions were guided by 3 frameworks (health information technology evaluation, access to care, and health information technology life cycle) and involved practice leaders' perspectives on the process of telemedicine implementation in their practice, with a specific focus on the process of maturation and facilitators/barriers. Two researchers conducted inductive coding of qualitative data open-ended questions to identify common themes. Transcripts were electronically generated by virtual platform software.

Results: Twenty-five interviews were administered for practice leaders representing 87 primary care practices in 2 states. We identified the following 4 major themes: (1) the ease of telemedicine adoption depended on both patients' and clinicians' prior experience using virtual health platforms, (2) regulation of telemedicine varied across states and differentially affected the rollout processes, (3) visit triage rules were unclear, and (4) there were positive and negative effects of telemedicine on clinicians and patients.

Conclusions: Practice leaders identified several challenges to telemedicine implementation and highlighted 2 areas, including telemedicine visit triage guidelines and telemedicine-specific staffing and scheduling protocols, for improvement.

Keywords: COVID-19 pandemic; East Coast; primary care; primary health care; telemedicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Humans
New York
Primary Health Care
Telemedicine* / methods
United States

Grants and funding

UL1 TR004419/TR/NCATS NIH HHS/United States