Patients with online access to their medical records and secure email communication with clinicians have increased use of clinical services, including office visits and telephone encounters, compared to patients who do not have online access. That’s the conclusion of a study published in the Nov. 21 issue of JAMA.
The finding contradicts prior studies that have suggested that providing patients with online access to health records and email communication with physicians may substitute for traditional health services such as clinical in-person visits or telephone calls, according to background information in the article. The study maintains that previous studies involved small numbers of patients and were conducted early in the implementation of patient online access.
In the study, Ted E. Palen, M.D., Ph.D., M.S.P.H., of the Institute of Health Research, Kaiser Permanente Colorado, Denver, and his colleagues, examined the use of healthcare services by group members 18 years or older, who were continuously enrolled for at least 24 months during the study period March 2005 through June 2010 in Kaiser Permanente Colorado. Utilization rates were calculated for both users and nonusers of My Health Manager (MHM), a patient online access system. The groups each contained 44,321 members. Member use of online access steadily increased from about 25 percent at the end of 2007 to 54 percent by June 2009. More than 45 percent of members with access to the MHM system used at least one of the system’s functions.
When they compared the use of clinical services before and after the index date between MHM users and nonusers, the researchers saw a significant increase in the per-member rates of office visits (0.7 per member per year) and telephone encounters (0.3 per members per year). They also found increases in the per-1,000 member rates of after-hours clinic visits (18.7 per 1,000 members per year), emergency department encounters (11.2 per 1,000 members per year), and hospitalizations (19.9 per 1,000 members per year) for MHM users compared to non-users. The utilization pattern was seen for members both younger and older than 50 years of age. More variability was found in rates of utilization by MHM users with chronic illnesses.
Among the possible explanations of the findings by the authors:
- Online access may have identified additional health concerns, leading to more use of in-person services;
- Members may have activated their online access in anticipation of health needs;
- Members who are already more likely to use services may selectively sign up for online access and use this technology to gain even more access rather than view it as a substitute for contact with the healthcare system.
Given the findings, the study concludes that healthcare delivery planners and administrators will need to consider how to allocate resources to deal with increased use of clinical services. Also, as online applications become widespread, healthcare delivery systems will need to develop ways to integrate health information technologies with in-person care, the study says.
The study was supported by Kaiser Permanente Colorado.