Patients with online records access will see doctor more

By Sarah Guy, medwireNews Reporter

Contrary to previous study findings, patients who have online access to their medical records and to medical services including appointment scheduling use more clinical services than their counterparts without access, show US research results.

In the year following activation of MyHealth Manager (MHM) at Kaiser Permanente Colorado (KPCO), USA, patients using the system had increased rates of office visits and telephone encounters per year compared with rates in the year prior to MHM activation.

There was also a significant increase in these rates among users compared with non-users of MHM, as well as an increase in other outcomes such as emergency department visits, report the researchers.

"Overall, our findings suggest that the relationship between online access and utilization is more complex than the simple substitution of online for in-person care," write Ted Palen (KPCO, Denver) and colleagues in the Journal of the American Medical Association.

They suggest the findings may result from MHM users identifying additional health concerns via online access; these users may have activated their online access in anticipation of health needs, and/or those who are already frequent service-users may have signed up to online access in order to gain more access to the healthcare system.

Data for 44,321 users and the same number of propensity-score matched non-users of MHM were analyzed for the study, which revealed a steady increase in online medical health access at KPCO from approximately 25% in 2007, to 53% in 2009.

The number of office visits per member per year increased significantly pre- to post-MHM implementation (2004 vs 2005-2010), from 2.7 to 3.2, while nonusers' office visits decreased by 0.2 per member per year in this time period.

Between MHM users and non-users, rates of office visits and telephone encounters increased significantly, by 0.7 and 0.3 per member per year, respectively.

In addition, Palen and colleagues observed significant increases in per-1000-member per year rates of after-hours clinic visits, emergency department encounters, and hospitalizations for MHM users compared with nonusers, with increases of 18.7, 11.2, and 19.9 respectively.

"As online applications become more widespread, health care delivery systems will need to develop methodologies that effectively integrate health information technologies with in-person care," conclude Palen et al.

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