Electronic visits (e-visits) have become a popular form of asynchronous, structured online care that allows patients to receive diagnoses and treatment for common outpatient conditions without an appointment. It offers 24/7 access and may help address gaps in primary care availability. There is limited evidence on how e-visits are used in integrated health systems or on how their results compare with those of telephone, video, and in-person visits.
This study aimed to evaluate the pattern of e-visit utilization, patient characteristics linked with their use, and short-term follow-up results as compared with other visit types of 4 conditions: urinary tract infection (UTI), acne, seasonal allergy, and international travel-related care in Kaiser Permanente Northern California (KPNC), a large integrated healthcare system.
The researchers performed a retrospective cross-sectional analysis of 73,560 initial outpatient contacts among adults in 2024, using 2023 and 2025 data to assess baseline comorbidities and follow-up visits. Eligible interactions included e-visits, telephone, video, and office visits that resulted in a clinical diagnosis. Only patients who were continuously enrolled for 1 year before and 1 month after the index visit were included. E-visits consist of structured questionnaires that trigger physician review and potential diagnoses, treatments, or referrals to another visit modality at KPNC. Telephone, video, and office appointments are accessible through the patient portal or the call center. ICD-10 codes were used to detect cases for 4 conditions, and follow-up visits for related diagnoses within 7 days were measured. Analysis used multinomial logistic, logistic, and modified Poisson regression to compare visit modality use, detect predictors of e-visit selection, and estimate adjusted follow-up rates, which account for language, early e-visit, and portal engagement.
This study found that e-visits accounted for about half of all initial encounters (34,895 of 73,560), with high use of UTI (58%) and international travel (56%), and lower but substantial use of seasonal allergy and acne (24% for each). Patients aged 30 to 39 were consistently more likely than those aged 18 to 29 to choose e-visits for seasonal allergies, acne, and travel, and for UTI white, English-speaking, commercially insured individuals with low comorbidity scores and early digital engagement showed the highest e-visits. Follow-up visits within 7 days were infrequent overall, with adjusted rates of 2.48% for UTI, 2.11% for acne, 6.45% for seasonal allergy, and only 0.12% for travel. E-visits had the lowest follow-up rate in all visit types for travel and UTI. For acne and seasonal allergies, office visits had slightly lower follow-up rates than e-visits. Risk factors for elevated follow-up after UTI e-visits involved age 65 or older, Asian or Latino race or ethnicity, and Medicaid insurance. At the same time, socioeconomic status showed no independent link for any condition.
A secondary analysis of 18,466 call center UTI encounters showed that call center and e-visit follow-up ratings were the same and that predictors of e-visit remain elevated. The results showed high patient preference for structured asynchronous e-visits even when other visit types are readily available, and the low follow-up rates indicate strong point-of-contact resolution comparable to or exceeding that of telephone, video, and office visits for most conditions.
This finding suggests that e-visits offer an effective, convenient modality to manage common outpatient problems and support their role in integrated health systems. The limitations included generalizability beyond the insured population, reliance on visits that resulted in clinician-assigned diagnoses, use of follow-up visits as a proxy for clinical outcomes, and exclusion of secure message follow-ups. This study provides robust evidence that structured e-visits can expand access, maintain quality, and serve as a valuable component of modern primary care delivery.
References: Lieu TA, Huang J, Tran K, Nguyen D, Reed ME. Electronic Visit Use and Resolution Rates for Adult Outpatient Conditions in an Integrated Care Setting. JAMA Netw Open. 2025;8(11):e2545761. doi:10.1001/jamanetworkopen.2025.45761
