Demographic disparities in video visit telemetry: understanding telemedicine utilization

To investigate demographic disparities in failed episodes of telemedicine utilization. The primary hypothesis was that certain demographic groups, including older adults and specific racial or ethnic groups, would experience disparate amounts of failed video visits.

A retrospective review was conducted using electronic health record-integrated scheduled telehealth video visit telemetry data gathered for all video visits at a California academic health center from September 1, 2020, to November 30, 2020. For each visit, we collected demographics including age, sex, ethnicity, primary language, and race.

Outcomes were categorized as successful or failed based on review of telemetry data. Successful visits were defined as simultaneous connections and completion of video visit, whereas failed visits were defined as provider-reported failure or lack of simultaneous connections for the telemedicine visit. Binomial generalized logistic regression using a generalized estimating equation approach was used to assess the impact of demographic factors on video visit success. Of 47,065 scheduled telemedicine video visits, telemetry data were available for 30,996; the 16,069 visits excluded from the study were due to no-shows, cancellations, or a nonintegrated solution being utilized.

Of 30,996 visits included in the study, 27,273 were successfully completed. Analysis of the 3723 failed visits revealed that older adults and African American/Black patients were more likely to experience failed video visits, with ORs of 2.02 and 1.56, respectively.

This study highlights the significant demographic disparities in failed video visit occurrence caused by technical failure as demonstrated by telemetry data. These findings highlight the need for targeted interventions and opportunity for improved outcomes.