Telehealth diagnoses match in-person clinical visit diagnoses in 86.9% of cases, study finds

• Overall, the telehealth diagnosis matched the in-person visit diagnosis in 86.9% of cases.
• For ICD-10 conditions, diagnostic agreement between telehealth visits and in-person visits ranged from 64.7% for diseases of the ear and mastoid process to 96.8% for neoplasms.
• In non-primary care specialties, diagnostic agreement between telehealth visits and in-person visits ranged from 77.3% for otorhinolaryngology to 96.0% for psychiatry.
• Diagnostic agreement between telehealth visits and in-person visits was significantly higher for specialty care compared to primary care (88.4% versus 81.3%).
• When an in-person visit diagnosis could be established through clinician opinion only, there was a high level of agreement with diagnoses made in telehealth visits.
• When an in-person visit diagnosis required confirmatory pathology, a physical examination, or neurological testing, there was a lower level of agreement with diagnoses made in telehealth visits.
• Among the 313 (13.1% of the total) cases where there was not agreement between the telehealth diagnosis and the in-person visit diagnosis, 166 cases had the potential for morbidity and 36 of those cases had actual morbidity.
• Among the 313 cases where there was not agreement between the telehealth diagnosis and the in-person visit diagnosis, 30 had the potential for mortality and 3 of those cases had actual mortality.

Telehealth diagnoses often should be paired with in-person visit diagnoses, the study’s co-authors wrote. “These findings suggest that video telemedicine visits to home may be good adjuncts to in-person care. Primary care video telemedicine programs designed to accommodate new patients or new presenting clinical problems may benefit from a lowered threshold for timely in-person direct follow-up in patients suspected to have diseases typically confirmed by physical examination, neurological testing, or pathology.”

Interpreting the data

The level of agreement between telehealth diagnoses and in-person visit diagnoses appears to be dependent on how the diagnoses are confirmed, the study’s co-authors wrote.

“In diagnoses confirmed through clinician opinion, such as many psychiatric diagnoses, there was a significantly greater concordance between video telemedicine diagnosis and in-person diagnosis. In diagnoses necessitating confirmation through traditional physical examination, neurological testing, and pathology—such as many otological and dermatological diagnoses—there was a significantly decreased concordance between video telemedicine and in-person diagnoses,” they wrote.

A primary result of the study was the difference in diagnosis agreement between specialty care versus primary care, the researchers wrote.

“One of the most salient findings in our study was the discrepancy between video telemedicine diagnostic concordance with in-person visits in specialty care (higher concordance) and primary care (lower concordance) clinical settings. This finding was further emphasized by our individual analyses of cases that resulted in morbidity and mortality. There were some cases identified in our primary-care telemedicine program that resulted in morbidity and mortality that might have been mitigated by an initial in-person visit, an observation that was not mirrored in specialty practices,” they wrote.