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  • Telehealth Landscape: Despite widespread adoption, telehealth engagement remains 11 times higher than pre-pandemic levels, with expectations of up to 60% of primary care going virtual in the next three to five years.
  • Challenges Behind Telehealth No-Shows: Patients missing telehealth appointments pose a challenge, often attributed to technical difficulties, perceptions of virtual appointments, lack of consequences, and the forgetfulness factor.
  • Solutions and Impact: Strategies like engaging patient communication through conversational text messaging, as implemented by Artera, have successfully cut telehealth no-show rates in half, addressing issues such as forgetfulness and improving the virtual care experience.

Telemedicine was supposed to reduce no-shows because there’s no barrier to seeing a doctor by video, right?

Not exactly.

It’s 2022. It’s been nearly two years since COVID-19 started sweeping across the world, accelerating the widespread adoption of telehealth solutions with it. 

Although usage has fallen slightly since its peak in 2020, telehealth engagement remains 11 times higher than before the pandemic. Many providers even believe that up to 60% of primary care will occur virtually in three to five years. Despite this growth, however, a significant number of patients still miss their telehealth appointments.

How can that be?

There’s more to the story than just the stats

According to Brandon M. Welch, PhD, Assistant Professor at Medical University of South Carolina and founder of telemedicine provider, it may not be due to the nature of the visit — by video instead of in person — but rather how the visit is promoted, scheduled, and implemented by the healthcare organization.

For example, many enterprise health systems offer telehealth visits with a pool of qualified physicians who may or may not be the patient’s primary care doctor. This variable alone could account for an apparent increase in no-show rates.

“So you’re not really comparing telemedicine to in-person because there is more than one variable,” Dr. Welch said. “To determine if no-show rates are really higher among telemedicine appointments, other variables (such as the provider-patient relationship) must be controlled.”

So, why aren’t patients showing up?

The no-shows in telemedicine are real. They present a hurdle to ensuring quality care for patients and create a financial and administrative burden for healthcare systems.

Patients miss their virtual visits for a variety of reasons. Here are the top five:

#5: Technical challenges

Technical challenges are one obvious barrier. If patients don’t understand how to use the technology, they are less likely to follow through with their appointment. Needing to download an app or log in to a patient portal both present opportunities to abandon the appointment. Passwords are forgotten. And sometimes, new tech is just confusing. Research indicates that usability issues at the initiation phase of the appointment account for the greatest patient frustration.

#4: When it’s not seen as a real appointment

Patients may think there’s no harm in not showing up for a virtual appointment — like they’re not hurting a real person or wasting real time. This is especially true when patients are seeing someone other than their primary care physician.

Despite an overwhelming satisfaction with telehealth, nearly 70% of patients continue to prefer in-person consultations. This is why experts like Welch believe telemedicine should be complementary to the traditional in-person care model.  

“The movement to replace in-person appointments with telemedicine will fail, along with quality and satisfaction of care, if it severs the patient-provider relationship,” he said. “Doctors need to adopt and add telemedicine as an option to their practice, rather than organizations trying to replace that traditional in-person relationship.”

#3: Thinking “I can just book another appointment!”

When there’s no consequence to the patient not showing up — no bill and no long wait time to reschedule another appointment — patients may be less motivated to keep their appointments.

It’s also worth noting that while telehealth enables patients to see their doctors virtually, the same technology allows them to seek appointments with other providers. According to the American Life Panel Survey by RAND, nearly a quarter (24%) of patients with a new condition scheduled phone visits with new doctors during the pandemic.

#2: No Good Reason

One of the toughest reasons to address may be the one that doesn’t exist. Sometimes human behavior is inexplicable, and people have no good reason for doing or not doing something.

#1: “I just forgot”

It’s easy to forget an appointment, especially when you are dealing with an illness or injury. Digital amnesia, forgetting information stored on a digital device, amplifies that tendency. When a patient makes an appointment online, they are more likely to need frequent reminders to keep it.


Engaging patient communication and delightful virtual experiences offer promising solutions to many of the reasons for virtual care no-shows. Artera partners with enterprise health systems offering virtual care and uses its conversational text messaging to reach patients where they already are — on their phones.

Artera clients have seen telehealth no-show rates cut in half — especially for patients who simply forget to attend. Before an appointment, a series of conversational messages are sent to help the patient log in to the portal and check in. Because the text appointment reminders are conversational, office staff can chime in when needed to help a patient get their appointment started.

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