The Role of Telehealth in COVID-19 Response

The rapid spread and severity of COVID-19 prompted a sudden shift from in-person to telehealth visits to reduce exposure risks, dramatically altering outpatient care patterns. Telehealth providers with national reach were uniquely positioned to supply near real-time clinical data that could help fill gaps in fragmented public health surveillance systems, which vary widely across states and often lack timely, comprehensive monitoring of COVID-19 cases. At the same time, disruptions in traditional healthcare and differences in outpatient management of respiratory infections, including off-label prescribing of treatments with limited supporting evidence, underscored the need to assess telehealth’s impact on clinical practices, patient outcomes, and public health reporting.

This study aimed to determine how telehealth data could improve COVID-19 case and mortality forecasting, identify differences in clinical practices between telehealth and urgent care, and examine the pandemic’s impact on ambulatory care-sensitive conditions and healthcare disparities. Data came from the nation’s largest telehealth provider combined with commercial and Medicare Advantage claims, enabling analysis of healthcare utilization, clinical outcomes, disparities, and public health surveillance during the pandemic. This work builds on prior efforts funded by the Agency for Healthcare Research and Quality that developed a surveillance system to monitor prescribing practices for respiratory infections and generate evidence-based notifications through electronic medical records. Leveraging this foundation, researchers examined the validity and utility of telehealth data to rapidly update and inform public health reporting and clinical practice during the COVID-19 pandemic.

The specific aims of the research were as follows:

• Assess the validity and timeliness of telehealth information for prospective public health surveillance.
• Assess the role of telehealth in responding to the primary impact of COVID-19.
• Assess the role of telehealth in responding to the secondary impact of COVID-19.

Researchers evaluated telehealth’s surveillance value by comparing case reports with laboratory-confirmed results and measuring their effect on short-term COVID-19 forecasts. They also compared diagnostic and treatment patterns for non-hospitalized COVID-19-like patients in telehealth versus urgent care settings, considering physician and patient characteristics. Planned analyses on the pandemic’s secondary impact on ambulatory care-sensitive conditions and disparities were not completed due to logistical constraints but provided a framework for future research.

The study showed that integrating telehealth data into public health reporting modestly improved short-term forecasting accuracy for COVID-19 cases and mortality. It also identified important shifts in clinical management: early in the pandemic, urgent care had higher rates of emergency department referrals and inappropriate prescribing, but these patterns changed over time. Findings have been shared with public health and clinical stakeholders to inform improvements in surveillance, healthcare quality, preparedness, and delivery strategies for future public health emergencies. Future work will explore disparities in ambulatory care-sensitive conditions amid telehealth expansion, assess telemedicine’s impact on care gaps and outcomes across diverse populations, and complete analyses of the long-term effects on healthcare quality and equity.