patients to e-mail their clinicians and access their records online is
associated with more, not fewer, telephone calls, office visits, and clinical
services in general, says a Medscape
Medical News article based on a study published in the
November 21 issue of JAMA.
Researchers studied the effect of an online Web
portal for patients enrolled in Kaiser Permanente (KP) Colorado. The portal,
called My Health Manager (MHM), connects to KP's electronic health record
system. MHM allows patients access test results, request medicine refills,
schedule nonurgent appointments, and exchange messages with their clinicians on
nonurgent health issues.
The authors measured the use of health care services by 44,321 users of MHM
before and after KP Colorado adopted the system compared with health care use
by an equal number of nonusers. All patients in the study were continuously
enrolled in KP Colorado for at least 2 years from March 2005 through June 2010.
Lead author Ted Palen, MD, PhD, MSPH, and
coauthors found that the number of office visits by MHM users increased by 0.7
per member per year compared with nonusers. Telephone encounters rose at a
smaller rate of 0.3 per member per year. The rates of after-hours clinic
visits, emergency department encounters, and hospitalizations per 1,000 members
per year rose significantly, by 18.7, 11.2, and 19.9, respectively. These
patterns held true whether the patients were younger or older than 50 years,
says the article.
In contrast, a 2007 KP study of this issue in the organization's Northwest
region reported that office visits decreased between 7% and 10% for patients
using the patient portal. At that time, however, only 6% of KP Northwest
patients were signed up for it. Today, roughly 50% of all KP patients, and
about 60% of those in Colorado, are logging on.
Online access might have helped patients take more responsibility for their
health care, which led them to use more services, Palen told Medscape
Medical News. Or perhaps patients who signed up for MHM were already likely
to use more services because of clinical characteristics that the study failed
to control for. Future research will try to tease out cause and effect, he
An even more important question to answer, said Palen, is the effect of the
online clinician–patient relationship on clinical outcomes. If virtual visits
lead to more face-to-face visits, does a patient's health necessarily improve
as a result?