Test Ordering and Completion During Virtual vs In-Person Annual Visits

Area of Science:

• Health Services Research
• Clinical Informatics
• Primary Care Medicine

Background:

• Telemedicine use is growing, but its impact on medical screening test ordering and completion is not fully understood.
• Previous observations suggest telemedicine is linked to reduced overall and low-value testing, but the reasons remain unclear.

Purpose of the Study:

• To compare the rates of ordering and completion for medical screening tests during virtual versus in-person annual visits.
• To analyze how these rates differ based on test value (high vs. low) and type (point-of-care vs. scheduled).

Main Methods:

• A cohort study analyzing electronic health record data from 22,547 matched virtual and in-person annual visits across 87 primary care practices.
• Data included 15 high- and low-value tests ordered and completed within 11 months post-visit, from January 2022 to October 2023.

Main Results:

• Both high- and low-value tests were significantly less likely to be ordered and completed during virtual visits compared to in-person visits.
• Low-value tests experienced a greater reduction in ordering (19.3%) and completion (17.3%) in virtual settings.
• Point-of-care laboratory tests showed larger decreases in ordering and completion at virtual visits compared to scheduled tests.

Conclusions:

• Virtual annual visits are associated with lower rates of ordering and completion for both high- and low-value medical tests.
• Telemedicine may introduce barriers that reduce testing, potentially impacting both high-value and low-value care.
• Health systems should consider implementing tools like gap closure alerts to ensure appropriate high-value testing in virtual care settings.