Telehealth Made EASY: Understanding Provider Perceptions of Telehealth Appropriateness in Outpatient Rheumatology Encounters.



The purpose of this study was to evaluate a novel scoring system, the Encounter Appropriateness Score for You (EASY), to assess provider perceptions of telehealth appropriateness in rheumatology encounters.


The EASY scoring system prompts providers to rate their own encounters as follows: in-person or telehealth acceptable, EASY = 1; in-person preferred, EASY = 2; or telehealth preferred, EASY = 3. Assessment of the EASY scoring system occurred at a single academic institution from January 1, 2021, to August 31, 2021. Data were collected in three rounds: 1) initial survey (31 providers) assessing EASY responsiveness to five hypothetical scenarios, 2) follow-up survey (34 providers) exploring EASY responsiveness to 11 scenario modifications, and 3) assessment of EASYs documented in clinic care.


The initial and follow-up surveys demonstrated responsiveness of EASYs to different clinical and nonclinical factors. For instance, less than 20% of providers accepted telehealth when starting a biologic for active rheumatoid arthritis, although more than 35% accepted telehealth in the same scenario if the patient lived far away or was well known to the provider. Regarding EASY documentation, 27 providers provided EASYs for 12,381 encounters. According to these scores, telehealth was acceptable or preferred for 29.7% of all encounters, including 21.4% of in-person encounters. Conversely, 24.4% of telehealth encounters were scored as in-person preferred.


EASY is simple, understandable, and responsive to changes in the clinical scenario. We have successfully accumulated 12,381 EASYs that can be studied in future work to better understand telehealth utility and optimize telehealth triage.






Published Version (Please cite this version)


Publication Info

Smith, Isaac D, Theresa M Coles, Catherine Howe, Robert Overton, Nicoleta Economou-Zavlanos, Mary J Solomon, Rong Zhao, Bhargav Adagarla, et al. (2022). Telehealth Made EASY: Understanding Provider Perceptions of Telehealth Appropriateness in Outpatient Rheumatology Encounters. ACR open rheumatology. 10.1002/acr2.11470 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Isaac David Smith

Assistant Professor of Medicine

Theresa Marie Coles

Assistant Professor in Population Health Sciences

Theresa Coles, Ph.D., is a health outcomes methodologist with a focus on measuring and evaluating patient-reported outcomes (PROs) and other clinical outcomes assessments (COAs), integrating PRO measures in clinical care, and improving interpretation of patient-centered outcome scores for use in healthcare delivery and clinical research settings to inform decision making.

My research program is comprised of 3 pillars:

  1. Enhance the assessment of physical function and related concepts to inform decision-making
  2. Improve interpretability of PRO scores
  3. Design and implement screeners to improve patient-centered care by measuring what matters

Megan Elizabeth Bowles Clowse

Associate Professor of Medicine

Dr. Megan Clowse is an Associate Professor of Medicine and Chief of the Division of Rheumatology and Immunology; she also holds joint appointments in the Department of Obstetrics and Gynecology and Population Health Sciences.  Her clinical research focuses on the management of rheumatic diseases in pregnancy. She has cared for over 1000 pregnancies in women with rheumatic disease, collecting information on these pregnancies initially in the Duke Autoimmunity in Pregnancy Registry and Repository, and the MADRA (Maternal Autoimmune Disease Research Alliance) registry and repository.  She served on the Core Leadership Team for the inaugural American College of Rheumatology's Reproductive Health Guidelines, published January 2020.  Dr. Clowse created and, websites dedicated to improving pregnancy planning and management for patients and rheumatologists.  

Dr. Clowse was the founding director of the Duke Lupus Clinic, where she continues to see patients each week and mentor junior faculty researchers.  The team has developed a new approach to lupus classification and management and is currently collecting and analyzing patient- and physician-reported measures to  better clarify this construct.  

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.