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Access to records increases clinical engagement


Patients with online access to their medical records and secure e-mail communication with clinicians made more use of clinical services, including office visits and telephone encounters, when compared with patients who did not have online access, according to a study.

Previous research posited that if patients could look up health information such as test results online, request prescription refills, schedule appointments or send secure e-mail to clinicians, their use of clinical in-person and telephone calls may decrease, said the authors of the new study, which appears in the Nov. 21 issue of the Journal of the American Medical Association. But “many previous studies involved small numbers of patients and were conducted early in the implementation of patient online access.”

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

The researchers calculated utilization rates for both users and nonusers of My Health Manager, 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. More than 45% of members with access used at least one My Health Manager function.

When the researchers compared the use of clinical services before and after the index date between My Health Manager users and nonusers, they saw a significant increase in the per-member rates of office visits and telephone encounters. They also found significant increases in rates of after-hours clinic visits ED encounters and hospitalizations for My Health Manager users compared with nonusers. The utilization pattern was evident for members both younger and older than 50.

“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,” the authors 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. As online applications become more widespread, healthcare delivery systems will need to develop methodologies that effectively integrate health information technologies with in-person care.”

David W. Bates, MD, MSc, and Susan Wells, MB, ChB, of Brigham and Women’s Hospital, Boston, wrote in an accompanying editorial that these findings may be disappointing for patient portal enthusiasts, but should not discourage organizations from increasing the use of electronic health portals by patients.

“Personal health records are here to stay, and the tethered architecture appears to offer the most benefits,” the authors wrote. “The data on utilization are uncertain and PHRs may not decrease healthcare utilization. However, electronic access to PHRs represents an extremely powerful tool from a variety of perspectives and can help empower and engage patients. More data on how to use them and on what specific modules and applications will be beneficial are clearly needed.”

The study is available at


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