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Online Access Increases Use of Clinical Services

Patients with online access to their medical records and secure e-mail communication with clinicians increased their use of clinical services, including office visits and telephone encounters, compared with patients who did not have online access, according to a study appearing in The Journal of the American Medical Association.

“Using health information technology to foster efficient healthcare delivery is an important component of healthcare reform,” according to background information in the article. “Prior studies suggest that providing patients with online access to health records and e-mail communication with physicians may substitute for traditional healthcare services.”

The presumption is if patients could look up their test results and other health information online; request prescription refills; schedule appointments; or send secure e-mail to clinicians, their use of clinical in-person visits and telephone calls may decrease. “Many previous studies involved small numbers of patients and were conducted early in the implementation of patient online access,” the authors stated.

Ted E. Palen, MD, PhD, MSPH, of the Institute for Health Research of Kaiser Permanente Colorado, and colleagues investigated the association between patient online access and their use of clinical services. The study examined the use of healthcare services by group members, who were aged 18 or older, who were continuously enrolled for at least 24 months during the study period of March 2005 through June 2010 in Kaiser Permanente Colorado, a group model, integrated healthcare delivery system.

Utilization rates were calculated for both users and nonusers of My Health Manager (MHM), a patient online access system. Member use of online access steadily increased from about 25% at the end of 2007 to 54% by June 2009 (n = 375,620). More than 45% of members with MHM access used at least one function. The refined groups each contained 44,321 matched members.

The researchers found that when they compared the use of clinical services before and after the index date between MHM users and nonusers, they saw a significant increase in the per-member rates of office visits (0.7 per member per year) and telephone encounters (0.3 per member per year).

“There was also a significant increase in 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 with nonusers,” the authors wrote. “This utilization pattern was seen for members both younger and older than 50 years.” MHM users with chronic illnesses found more variability in rates of utilization.

The authors suggested several possible explanations for these findings. “Online access to care may have led to an increase in use of in-person services because of additional health concerns identified through online access,” they wrote. “Members might 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 then use this technology to gain even more frequent access rather than view it as a substitute for contact with the healthcare system.

“If these findings are evident in other systems, healthcare delivery planners and administrators will need to consider how to allocate resources to deal with increased use of clinical services,” they continued. “As online applications become more widespread, healthcare delivery systems will need to develop methodologies that effectively integrate health information technologies with in-person care.”

— Source: American Medical Association