Table 1. Themes and subthemes of vPCP focus groups.

	Theme	Subthemes	Definition
Advantages	Convenience/access: More convenient and easier to access than a human physician	Routine illnesses	Convenient to use for common illnesses like common cold, upper respiratory infections, etc.
		Transportation	Do not have to travel to clinic/hospital
		Anytime, anywhere	Can use vPCP outside of business hours, during weekends, from any location
	Efficiency: More efficient than human physician	One-stop shop	Can address multiple concerns, multiple specialties during one visit
		Knowledge support	Can provide additional information and second opinions to physician
		Physician support	vPCP can provide basic support (documentation, simple visits, etc.) so that physicians can concentrate on more complex tasks (diagnostics, complex patient care, etc.)
	Lower cost: Would cost less than a human physician, for patients and systems	Money	Less expensive for systems, potentially less expensive for patients
		Time	Saves patient time for travel, waiting, etc
		Manpower	Less front desk/support staffing may be needed; reduced demands on at-home caregivers
	Accuracy: More accurate than human physician	Human error	Lower likelihood of mistakes
		Information capacity	Humans are limited in their capacity to remember information, machines can hold nearly unlimited information
		Diagnostic bias	May be more likely to consider all possibilities, physicians may be biased to common illnesses
	Reduced stigma: A vPCP would not operate using stigma or bias	Discrimination	Cannot discriminate by race/ethnicity/socioeconomic status, etc., consciously or unconsciously
		Embarrassment	Can speak about “embarrassing” issues more freely, lack of human contact can reduce stigma/embarrassment
Disadvantages	Data security: Patient medical data could be stolen or hacked	Information theft	Information could be susceptible to theft, hacking, unauthorized sharing
	Humanness: Human interaction would be lost when using a vPCP	Physical exam	Cannot perform physical exam
		Shared decision-making	Patients aren’t involved in the decision- making process
		Patient compliance	Compliance may be lower if the patient does not receive instructions from a human physician
	Misdiagnosis: How would mistakes be handled when using a vPCP?	Accountability	Who is accountable when mistakes happen? Company, hospital, data source?
		Reporting inaccuracy	Mistakes could be made if patients misunderstand their symptoms or enter misleading information
	Suitability: A vPCP would not be appropriate in all cases	Rare conditions	A vPCP could not make decisions about rare or new conditions, since there is not enough data available
		Mental health	Human connection is important for those experiencing depression, social isolation, etc.
Future	Physicians: a vPCP would be used in tandem with a human physician	Cannot replace	Cannot ever replace a human physician. Can only be a tool for them.
		Data checking	Human physicians must check and verify the data entered into the vPCP
	Patients: A vPCP could be used to enhance patient care	Patient engagement	Patient education and engagement could be personalized instead of generic printouts generated by the electronic health record
		Chronic conditions	Easier to monitor chronic conditions
	Population health: A PCP would be a valuable epidemiological tool	Epidemiology	Could monitor disease prevalence and outbreaks, locally and worldwide
	Data technology: A future vPCP must include certain technologies	Dynamic system	System must change and add new data constantly as we learn new things
		Adequate testing	Must be sufficiently tested and proven before rollout
		Trustworthy data	Data must be sufficient and informed by multiple sources without interests
		Transparency	Algorithm source (design/funding), data ownership, sharing/selling of data must be transparent to patients