Telehealth visits not to blame for uptick in imaging orders, study shows
Despite some assumptions that telehealth visits increase the unnecessary utilization of diagnostic services like medical imaging, new data suggest the opposite may be true.
During the height of the COVID-19 pandemic, telemedicine visits became the go-to solution for many organizations striving to continue caring for their patients’ nonurgent needs while also mitigating the spread of the virus. Though telehealth helped to bridge the care gap at that time, some providers expressed concern about how virtual visits might lower the standard of care and lead to an uptick in unnecessary testing.
But according to a poster presentation at the annual RSNA meeting, telehealth did not greatly contribute to imaging workloads. In fact, experts observed significantly fewer orders from telehealth compared to in-person visits during the timeframe analyzed.
“As telehealth services, including telephone and video appointments, become increasingly popular, it is crucial to evaluate their effectiveness, efficiency and impact on clinical decision-making,” Ahmad Alach, of the Kaiser Permanente Bernard J. Tyson School of Medicine in California, and colleagues write. “The advent of telehealth, especially since the onset of the COVID-19 pandemic, has raised questions about how telehealth may impact the utilization rates of diagnostic imaging studies.”
At the start of their analysis, the group hypothesized that telehealth visits would spur higher rates of imaging orders. They included nearly 1.3 million nonurgent primary care visits that took place within the Kaiser Permanente Southern California health system between March 2018 to April 2022. Of these, 943,593 (74.8%) were conducted in person, while 280,038 (22.2%) were telephone visits and 38,618 (3.1%) were video calls.
The group narrowed their search by looking at visits that resulted in orders for imaging due to back, knee or abdominal pain. Compared to telehealth, in-person consultations produced significantly more imaging requisitions. Visits for knee pain were more likely to result in an order, potentially due to acute injuries or the likelihood that a patient may have a degenerative condition that would be visible on X-ray exams.
“Contrary to our hypothesis, clinicians did not order more imaging for telephone and video visits,” the group notes. “This suggests that physical exams and diagnostic imaging are not directly interchangeable.”
The research uncovered disparities in who imaging requests were submitted for—Black, Hispanic and Asian patients were much less likely to be sent for imaging compared to White patients. The team also notes that internal medicine providers were more likely to submit requests for additional testing following virtual visits.
As expected, the onset of COVID triggered an uptick in requisitions from telehealth providers, but not disproportionately so.
The authors acknowledge that their study had limitations, including a lack of data on telehealth provider requests for follow-up visits to examine patients further before ordering additional tests.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.