Appropriate use of Telehealth Visits in Endocrinology

Policy Perspective of the Endocrine Society

Varsha G. Vimalananda; Juan P. Brito; Leslie A. Eiland; Rayhan A. Lal; Spyridoula Maraka; Marie E. McDonnell; Radhika R. Narla; Mara Y. Roth; Stephanie S. Crossen


J Clin Endocrinol Metab. 2022;107(11):2953-2962. 

In This Article

Abstract and Introduction


Objective: This work aims to guide clinicians practicing endocrinology in the use of telehealth (synchronous patient-clinician visits conducted over video or telephone) for outpatient care.

Participants: The Endocrine Society convened a 9-member panel of US endocrinologists with expertise in telehealth clinical care, telehealth operations, patient-centered care, health care delivery research, and/or evidence-based medicine.

Evidence: The panel conducted a literature search to identify studies published since 2000 about telehealth in endocrinology. One member extracted a list of factors affecting the quality of endocrine care via telehealth from the extant literature. The panel grouped these factors into 5 domains: clinical, patient, patient-clinician relationship, clinician, and health care setting and technology.

Consensus Process: For each domain, 2 or 3 members drew on existing literature and their expert opinions to draft a section examining the effect of the domain's component factors on the appropriateness of telehealth use within endocrine practice. Appropriateness was evaluated in the context of the 6 Institute of Medicine aims for health care quality: patient-centeredness, equity, safety, effectiveness, timeliness, and efficiency. The panel held monthly virtual meetings to discuss and revise each domain. Two members wrote the remaining sections and integrated them with the domains to create the full policy perspective, which was reviewed and revised by all members.

Conclusions: Telehealth has become a common care modality within endocrinology. This policy perspective summarizes the factors determining telehealth appropriateness in various patient care scenarios. Strategies to increase the quality of telehealth care are offered. More research is needed to develop a robust evidence base for future guideline development.


Telehealth includes many types of medical care delivered remotely using telecommunications technology.[1] In this policy perspective (herein referred to as "perspective") the term telehealth refers to synchronous patient-clinician visits conducted over video or telephone for outpatient care. Endocrinology as a specialty lends itself well to telehealth because the diagnosis and management of many endocrine conditions rely primarily on patient-reported history, laboratory, and/or imaging results rather than physical examination findings. Before the COVID-19 pandemic telehealth was already being used in endocrinology, most frequently for diabetes care.[2–4] At the outset of the pandemic, changes in reimbursement models and the recognition of home as an "originating site" of care enabled broader use.[5] Endocrinology evolved into one of the subspecialties with the highest shares of visits conducted via telehealth,[6] and endocrine and metabolic conditions are now among the most common conditions addressed across all telehealth visits.[7] Benefits of telehealth have emerged compared to in-person care across health systems, and include higher visit completion rates[8] and a reduction in patients' travel burden, with generally high patient[9–11] and clinician satisfaction.[12,13] At the same time, concerns have arisen about the equity, safety, and effectiveness of telehealth in different situations.[14–16]

Telehealth will likely remain a common modality for endocrine care after conclusion of the current public health emergency (PHE). Thus, clinicians will need to decide whether it is appropriate to use telehealth outside a PHE for specific types and instances of endocrine care. Few empiric data are available to guide decisions about when to leverage telehealth or in-person encounters for endocrine outpatient care. This perspective aims to provide guidance on that topic by outlining how various domains of care—including clinical factors, patient factors, the patient-clinician relationship, clinician factors, and the health care setting—can influence the use of telehealth within endocrinology, and how this, in turn, can affect the overall quality of care provided. We also offer strategies to support high-quality endocrine care rendered via telehealth. Finally, we identify where future research is needed on quality of telehealth care in endocrinology.