Test Ordering and Completion During Virtual vs In-Person Annual Visits.

Importance: Telemedicine use has been associated with lower rates of overall testing and low-value testing, but the underlying mechanisms are unknown. Objective: To compare medical screening test ordering and completion rates between in-person and virtual annual visits, and to determine how these rates varied by test value (high vs low) and test type (point of care vs scheduled). Design, Setting, and Participants: This cohort study used electronic health record data on virtual and in-person annual visits conducted between January 1, 2022, and October 25, 2023, among adult patients at 87 primary care practices in a large health system. Data were analyzed from September 2024 to June 2025. Exposure: Virtual or in-person annual visit. Main Outcomes and Measures: Rates of ordering and completion of 15 high- and low-value tests within 11 months after visit. Results: A total of 22 547 matched in-person and virtual visits were examined involving 20 948 patients (mean [SD] age, 51.0 [15.9] years, 14 502 women [69.2%]). All 15 high- and low-value tests were more likely to be ordered and completed at in-person vs virtual visits; generally, high-value tests were more likely to be ordered and completed than low-value tests. At virtual compared with in-person visits, high-value tests were 14.3% (95% CI, -15.5% to -13.2%) less likely to be ordered (relative to the 54.8% in-person rate) and 13.1% (95% CI, -14.1% to -12.0%) less likely to be completed (relative to the 87.7% in-person rate). Low-value tests were 19.3% (95% CI, -21.0% to -17.5%) less likely to be ordered (27.8% in-person rate) and 17.3% (95% CI, -18.5% to -16.1%) less likely to be completed (91.1% in-person rate). When compared with scheduled tests, point-of-care laboratory tests had larger decreases at virtual versus in-person visits in ordering (-18.5% [95% CI, -19.9% to -17.1%] relative to 37.7% in person, vs -11.6% [95% CI, -13.6 to -9.6] for scheduled tests [26.8% in person]) and completion (-16.3% [95% CI, -17.3 to -15.3]; 93.7% in person, vs -6.2% [95% CI, -8.9 to -3.4]; 63.0% in person). Conclusions and Relevance: In this cohort study, high- and low-value tests were less likely to be both ordered and completed at virtual annual visits compared with in-person annual visits, particularly low-value tests and laboratory tests. Telemedicine may introduce frictions for clinicians and patients that differentially reduce low-value testing, although high-value tests were also affected; health systems could consider tools, such as gap closure alerts, to selectively promote high-value care.