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More or Less: Exploring the Impact of Patient Portal Usage

December 12, 2012
by Gabriel Perna
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Various researchers at the Oakland, Calif.-based integrated healthcare organization, Kaiser Permanente, recently conducted a study attempting to link patients’ access to their record online and how often they visit a doctor’s office. Having seen numerous studies on this topic before, the researchers came in expecting one thing and found out something entirely different.

Ted Palen, M.D., Ph.D., a clinician researcher at Kaiser Permanente’s Institute for Health Research, explained in an exclusive interview with Healthcare Informatics why he and his fellow researchers were surprised by the fact that users of Kaiser’s personal health record (PHR), My Health Manager, had 16 percent more office visits than those who weren’t users of it.

“The results of the study surprised us because we went in with hypothesis that, and it had been written about in several other informatics type publications, online access may substitute for the need for in-person services,” Dr. Palen says. “What we saw was an association, not a cause and effect, but an association with those patients with online access and both an increase in phone traffic to the clinics and office visits.”

Previous studies, Palen says, had found just the opposite. In fact, a Kaiser study in Hawaii had seemingly confirmed the belief that patient access to an online portal decreased the amount of office visits, in that case by 26.2 percent.

Starting with an examination of the records of more than 500,000 Kaiser Permanente patients in the state of Colorado, Palen and his team whittled the research down to 44,000 My Health Manager users and 44,000 non-users. Along with finding out that users of the portal, and its accompanying services such as lab results and secure messaging, were more likely to visit a physician, the researchers also saw an increase in utilization to after-hour clinic visits, emergency department visits, and even hospitalizations.  Furthermore,My Health Manager users who had asthma or diabetes also had increased rates of office visits, 15 percent and 13 percent respectively, the researchers found.

“This may be a good news story in the sense that does this really point to a measure of patient engagement in their healthcare,” Palen suggests. “In that year following the time they signed up, they’re more engaged in their healthcare, identifying the issues they need to take care of, and maybe down the road they’re need for the use of these services may decrease. We don’t know though.”

Not only was it surprising to Palen and his team that this was consistent across varying clinical services, but they were also shocked that their findings were true across all ages and genders. According to Palen, the people you wouldn’t expect to be tech-savvy, the 50 and older crowd were using the portal just as much as the younger crowd.

Working as a practitioner, Palen said he saw this kind of engagement firsthand. “I was working in an after-hours clinic a few weeks ago and a patient came in. I did some blood tests, and some other testing. I looked them up on my computer, and was going back to give them these test results in the exam room, and when I went back in, the patient was already looking up the results on the iPhone,” explains Palen.

“What it does is change the dynamic of the conversation. Instead of spending time explaining the results, it’s more of a partnership, we can talk about a treatment plan,” he adds.

There are a lot of unanswered questions in Palen’s view, some of which can be explored through further research. For one, he says he and his colleagues want to find out if this truly is a measurement of patient engagement. If it is, he wonders, what effect does it have on their health status down the road? Another area that could use added investigation is figuring out what kinds of services through a patient portal are patients accessing and using. Then, he says, he’d like to use that information to figure out what that means what for their health outcomes and the demands on the healthcare delivery system.

Palen also would like to explore how medical training prepares clinicians for dealing with patient care in a virtual system, such as emailing through portals, telemedicine, and remote monitoring. He suggested that one of the possible reasons for the uptick of office visits in this study is that providers are still figuring out how to handle virtual healthcare.

“It might just be easier for them to say, ‘come on in’ to a patient,” Palen says. “Physicians haven’t been trained in this area, and we may need new training tools to be able to do patient care in a virtual environment.”