About 54% of Americans used telehealth in the past year. That number, from early 2025 survey data, would have been unthinkable in 2019. The pandemic forced a mass experiment in virtual care, and much of it stuck. But the question patients keep asking — and the one clinicians keep debating — is whether a video call can actually replace sitting in an exam room.
The answer, based on what research exists so far, is: it depends on what you're there for.
"The available evidence on the effectiveness of telehealth versus in-person care during the pandemic [is] weak and heterogeneous." — Shi et al., Nature Digital Medicine (2024)
What the systematic reviews actually say
The most comprehensive comparison to date is a 2024 systematic review published in Nature Digital Medicine by Shi et al. The researchers set out to compare telehealth and in-person care during the COVID-19 era and found something frustrating but honest: the evidence is mixed and mostly observational. Randomized controlled trials comparing the two modalities are rare, because the pandemic didn't exactly lend itself to careful experimental design.
What the available studies do suggest is that clinical outcomes — things like symptom reduction, disease control, and treatment completion — are broadly comparable for many conditions. Patients didn't get worse care because they switched to video. But "broadly comparable" isn't the same as "identical," and the gaps matter.
A separate study from the Kaiser Permanente system, published in the Journal of General Internal Medicine (Ashwood et al., 2021), examined mental health outcomes specifically. Their large-sample analysis found that telehealth patients showed similar symptom improvement to in-person patients across depression and anxiety measures, with no statistically significant difference in treatment completion rates.
Where telehealth works well
Two areas stand out in the research.
Chronic disease management is probably the strongest use case. Patients with diabetes, hypertension, heart failure, and COPD need regular check-ins that are mostly conversational — reviewing medication, discussing symptoms, adjusting treatment plans. The Doximity 2024 State of Telemedicine Report found that telemedicine plays a "particularly important role" for patients with chronic illness, and usage rates among this group remain high. The Urban Institute reported similar findings: adults with chronic conditions who used telehealth generally found it adequate for ongoing management.
Mental health is the other clear winner. Behavioral health leads telehealth adoption by a wide margin — Epic Research data shows it consistently has the highest utilization rates among all specialties. This makes sense. Therapy and psychiatric consultations are primarily verbal. The therapist doesn't need to touch you. A 2021 study in PMC (Comparing efficacy of telehealth to in-person mental health care) found that despite the difference in delivery method, telehealth was as effective as in-person care for mental health outcomes across a large health system sample.
The eSMED (European Society of Medicine) review of telebehavioral counseling went further, noting that existing meta-analyses show similar symptom reduction between telehealth and in-person counseling, with improvements maintained at both three- and six-month follow-up.
Where telehealth falls short
The physical exam is the obvious weak point. A clinician on a video call can see you, hear you, and ask questions. They cannot take your blood pressure, listen to your lungs, feel for swollen lymph nodes, or check your reflexes.
This matters more for some specialties than others. Orthopedic surgery has some of the lowest telehealth adoption rates for good reason — you can't assess a torn ACL through a screen. Dermatology occupies an interesting middle ground: some conditions photograph well enough for remote diagnosis, others don't. Primary care lands somewhere in between, with an AMA report showing telehealth use in 2024 at roughly triple pre-pandemic levels but still representing a minority of total visits.
The lack of vital signs is a specific, measurable problem. Vital signs — heart rate, respiratory rate, blood pressure, oxygen saturation — are the foundation of a clinical assessment. They tell the clinician whether a patient is stable or deteriorating before any other evaluation happens. In a traditional visit, measuring vitals takes about 90 seconds. In a telehealth visit, the clinician gets nothing unless the patient happens to own a blood pressure cuff or pulse oximeter.
A 2022 review in the journal Connected Health and Telemedicine described this gap directly: "The lack of a comprehensive physical examination is a major limitation of telemedicine. Vital signs are the foundation of an exam and inform the clinician about the acuity of a patient's overall condition."
Telehealth vs in-person care by condition type
| Condition area | Telehealth effectiveness vs in-person | Key limitation | Vital signs needed? |
|---|---|---|---|
| Depression and anxiety | Comparable outcomes in meta-analyses | Crisis situations may need in-person | Helpful but not primary |
| Diabetes management | Similar HbA1c control reported | Foot exams, wound checks harder remotely | Yes — blood pressure, heart rate |
| Hypertension follow-up | Effective for medication adjustment | Requires patient-owned BP monitor | Yes — blood pressure is central |
| COPD management | Adequate for routine check-ins | Exacerbations need in-person assessment | Yes — respiratory rate, SpO2 |
| Post-surgical follow-up | Effective for wound check via photo | Complex wound assessment limited | Yes — heart rate, respiratory rate |
| Acute abdominal pain | Not recommended | Requires palpation, imaging | Yes — full vitals critical |
| Musculoskeletal injury | Limited utility | Requires range-of-motion testing | Less central |
| Dermatology | Variable — depends on condition | Image quality affects diagnosis | Usually not primary |
Sources: Shi et al. (2024), Doximity (2024), AMA (2024), eSMED (2024).
The vital signs gap in virtual care
Here's what makes the physical exam limitation more than an abstract concern. When a patient calls in with shortness of breath, the clinician's first instinct is to check respiratory rate and oxygen saturation. When someone reports chest tightness, heart rate and blood pressure matter immediately. Without those numbers, the clinician is working with subjective descriptions only — and patients are notoriously unreliable narrators of their own physiology.
Some health systems have tried mailing patients monitoring devices. It works, but it's expensive, slow, and the devices end up in a drawer after the first month. Consumer wearables help for some metrics, but they're inconsistent across brands and not clinically validated for most use cases.
Camera-based contactless vital sign measurement offers a different approach. Using rPPG (remote photoplethysmography), a standard smartphone camera can detect subtle color changes in facial skin caused by blood flow, extracting heart rate and respiratory rate without any additional hardware. The patient is already on camera for the video visit. The vital sign measurement happens through the same device they're already using.
A 2023 study on the medRxiv preprint server evaluated a smartphone rPPG application and found it provided "a convenient contactless video-based remote solution" that worked on any modern smartphone. A 2025 review in Frontiers in Digital Health surveyed the broader rPPG literature and confirmed the approach's potential for health assessment, while noting that challenges around motion artifacts, lighting conditions, and skin tone variability still need addressing in real-world deployment.
This technology doesn't replace a stethoscope or a CT scan. But it fills a specific, well-defined gap: giving telehealth clinicians objective physiological data during a virtual visit, using equipment the patient already owns.
What this means going forward
Telehealth isn't going away. The utilization rates have plateaued but at levels far above pre-2020 baselines, and the evidence supports its continued use for the conditions where it works well. The real question is how to expand what "works well" covers.
The missing piece has always been objective clinical data during virtual visits. If a primary care physician could see a patient's heart rate, respiratory rate, and blood pressure trend during a routine telehealth check-in — without asking the patient to buy anything — the gap between virtual and in-person care narrows considerably.
Circadify is developing contactless vital sign measurement technology using rPPG that could be integrated into telehealth workflows. The company's camera-based approach is designed to extract physiological signals from a standard video feed, which aligns with the specific limitation that researchers and clinicians have repeatedly identified in virtual care.
The research is clear that telehealth works for many things. It's equally clear about where it doesn't. Closing that gap isn't about choosing between virtual and in-person — it's about making virtual visits more clinically complete.
Frequently Asked Questions
Is telehealth as effective as in-person visits for most conditions?
For many conditions, yes. Systematic reviews show comparable outcomes for chronic disease management, mental health treatment, and routine follow-ups. A 2024 Nature systematic review found that telehealth and in-person care produced similar clinical outcomes across multiple specialties, though the evidence base consists mostly of observational studies rather than randomized trials.
Where does telehealth fall short compared to in-person care?
The biggest gap is the physical examination. Clinicians cannot palpate, auscultate, or measure vital signs through a video call using standard tools. Conditions requiring hands-on assessment — acute abdominal pain, musculoskeletal injuries, skin lesions needing close inspection — are harder to evaluate remotely. This limitation is one reason telehealth adoption varies so much by specialty.
How can contactless vital signs improve telehealth visits?
Camera-based rPPG technology can extract heart rate, respiratory rate, and other physiological signals from a standard smartphone camera during a video visit. This addresses one of telehealth's main limitations by giving clinicians objective vital sign data without requiring patients to own any additional hardware.
What percentage of Americans use telehealth?
As of early 2025, approximately 54% of Americans report having used telehealth within the past year. Usage varies significantly by specialty — behavioral health leads adoption, while surgical specialties remain mostly in-person. The overall telehealth utilization rate across all specialties sits around 6.7% of total visits.