Telehealth Use Remains High in Mental Health, Infectious Disease Care

While telehealth use has dropped nearly 25 percentage points from peak usage in 2020, certain specialties, like mental health, infectious disease, and obstetrics, still have higher-than-average telehealth use, according to new data.

The data from Epic Research aims to provide insights into telehealth use trends across specialties in 2023 compared to before and during the peak of the COVID-19 pandemic. Researchers analyzed 475 million telehealth and in-person visits between the second quarter (Q2) of 2019 and the third quarter (Q3) of 2023. The data was gathered from Cosmos, a collaboration of 222 health systems using Epic EHRs. The dataset represents over 220 million patient records from all 50 states and Lebanon.

Telehealth usage skyrocketed during the initial peak early in the pandemic but has since declined, though usage remains higher than pre-pandemic levels. The data shows telehealth use encompassed less than 1 percent of all visits in the last three quarters of 2019. This figure jumped to 31.2 percent in Q2 2020 before dropping to 5.8 percent in Q3 2023.

The proportion of telehealth visits peaked across all specialties in Q2 2020, with the highest telehealth use rates seen in mental health (65.5 percent), endocrinology (55.5 percent), geriatrics (55.2 percent), transplant (52.2 percent), and gastroenterology (51.5 percent).

Mental health has continued to rank highest among the specialties still using telehealth widely in 2023.

By Q3 2023, 37 percent of mental health visits were occurring virtually, followed by infectious disease (11 percent), obstetrics (10 percent), and transplant (10 percent).

At the other of the spectrum, the specialties with the lowest telehealth rates in Q2 2020 and Q3 2023 were orthopedics, ophthalmology, podiatry, and wound care.

In Q2 2020, 10.4 percent of orthopedics, 7.7 percent of ophthalmology, 4.7 percent of podiatry, and 4.6 percent of wound care visits were performed via telehealth. By Q3 2023, 1.1 percent of orthopedics, 0.6 percent of ophthalmology, and 0.2 percent of podiatry and wound care visits were virtual.  

“This likely reflects the hands-on nature of the care provided by these specialties,” the Epic researchers noted.

The data aligns with other research on telehealth usage trends published in 2023.

A report by market research firm Trilliant Health revealed that the number of telehealth visits dropped from 76.6 million visits in Q2 2020 to 41.5 million visits in the fourth quarter (Q4) of 2022, representing a 45.8 percent decline.

The report also shows that more than half of physicians (61 percent) and a third of patients (33 percent) believe that video visit quality is worse or much worse than in-person visit quality.

However, in contrast to overall telehealth visit volume, the share of telehealth visits for behavioral health conditions jumped from 41.8 percent in Q1 2020 to 62.8 percent in Q4 2022.

Similarly, telehealth use for pediatric mental healthcare soared during the pandemic. One analysis published in October shows that pediatric telemental health service utilization rose 2,300 percent higher than pre-pandemic levels in August 2022.

The researchers examined pediatric mental health service utilization and spending rates from January 2019 through August 2022 and the proportion of utilization and expenditure associated with telehealth and in-person visits.

Between March 13, 2020, and December 17, 2020, in-person pediatric mental health services declined by 42 percent compared with utilization in the pre-pandemic phase, while telehealth services skyrocketed by 3,027 percent.

By August 2022, in-person services had returned to 75 percent of pre-pandemic utilization, but telehealth-based pediatric mental health utilization was 2,300 percent higher than pre-pandemic levels.