Primary Care in the Age of Telemedicine: Diagnoses and Physician Time Across Visit Modalities

Yochai Schonmann, Lilach Aizenbud

Keywords: Primary care, visit duration, diagnoses, time allocation, telemedicine, electronic health records, reasons for encounter

Background:

Synchronous- and asynchronous telemedicine visits are replacing a growing proportion of primary care physicians' face-to-face visits. However, little is known about the distribution of time spent on clinical and administrative tasks across visit modalities.

Research questions:

To identify the most common diagnoses in contemporary primary care and explore variations by visit type (face-to-face, synchronous-, and asynchronous-telemedicine).

Method:

A population-based cross-sectional analysis of routinely collected primary-care data from Clalit Health Services. We extracted data for all primary care visits in 2023 and used visit duration to estimate the total annual time spent on each recorded diagnosis.

Results:

4,480 physicians recorded a total of 40,965,318 diagnoses in 29,625,207 primary care visits, spanning 4,236,266 hours. Of all visits, 55.2% of annual-visit-time was face-to-face (45.8% of visits; mean visit duration 10.4±8.2 minutes), 15.5% was synchronous-telemedicine (14.5% of visits; mean visit duration 9.3±8.2), and 29.2% of annual-visit-time was asynchronous-telemedicine/administrative (39.7% of visits; mean visit duration 6.4±8.0).
53.3% of total visit time was attributed to clinical diagnoses, 38.4% to administrative-related diagnoses, and 8.3% to non-specific, "general" diagnoses. Administrative work accounted for 22.9% of face-to-face time, 25.4% of synchronous telemedicine time, and 74.9% of asynchronous time. The ten most common clinical diagnoses—representing 22.2% of annual-visit-time— were: low back pain; upper respiratory infections; abdominal pain; cough; diabetes; viral infections, unspecified; urinary tract infections; tonsillitis, acute; hypertension; and headache. Common diagnoses were very similar for face-to-face and synchronous telemedicine visits; chronic disease diagnoses were more prevalent in asynchronous visits.

Conclusions:

The most common diagnoses were similar across face-to-face and synchronous telemedicine visits. A significant proportion of physicians' time was dedicated to administrative tasks.

Points for discussion:

What other differences between visit modalities should be explored?

How can we explore and compare quality of care through such EHR-based studies?

Which are meaningful ways to group and depict the most common diagnoses?

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