Author Insights: Access to Online Medical Records May Increase Use of Medical Services

Ted E. Palen, MD, PhD, MSPH, and colleagues from Kaiser Permanente’s Institute for Health Research in Denver found that patients with online access to their medical records used more health care services than those without access. Image: Kaiser Permanente

Patients with online access to their medical records used more health care services than did patients without online access, found a study published in JAMA today.

Electronic medical records and other new technologies have been proposed as tools to help improve the efficient delivery of medical care. So far, however, studies have had mixed findings, particularly with regard to whether these technologies reduce costs or use of health care services.

Kaiser Permanente Colorado, which provides health care services to more than 535 000 members in the state, has had an integrated electronic medical records system in place since 2004 and added an online portal called MyHealthManager in 2006 that allows patients to view their own medical records. To probe the effect of using the portal on patients’ use of health care services, scientists from Kaiser Permanente’s Institute for Health Research in Denver conducted a retrospective cohort study of Kaiser members who used the portal and a matched group of members who didn’t. Compared with Kaiser members who did not use the portal, those who did increased their use of a number of health care services, including office visits per year (an additional 0.7 visits per member per year, on average), telephone consultations (an additional 0.3 telephone consultations per member per year), visits to after-hours clinics (an additional 18.7 visits per 1000 members per year), emergency department visits (an additional 11.2 per 1000 members per year), and hospitalizations (an additional 19.9 per 1000 members per year). Continue reading

Author Insights: Home Telemonitoring Does Not Reduce Hospitalizations or Emergency Department Visits for Seniors

Paul Y. Takahashi, MD, MPH, an associate professor of medicine at the Mayo Clinic in Rochester, Minn, and colleagues found that tracking older patients at home through telemonitoring did not lead to fewer hospitalizations or emergency department visits. (Image: Mayo Clinic)

A telemonitoring device in the home that can measure and transmit information about indicators of health such as blood pressure and oxygen saturation coupled with videoconferencing can allow a health care team to assess a patient’s condition remotely and discuss ongoing treatment plans with the patient. Proponents of telemonitoring suggest that it has the potential to improve patient outcomes, but recent studies suggest such optimism may be premature. New findings appearing in the May 28 Archives of Internal Medicine found that telemonitoring of older adults with multiple health issues did not reduce hospitalizations and emergency department visits.

The findings are based on a study of 205 individuals with an average age of about 80 years and multiple chronic conditions who were randomly assigned to receive telemonitoring or usual care at 4 Mayo Clinic sites in Minnesota. After 12 months, the researchers found no difference in rates of hospitalization or emergency department visits between the 2 groups. Continue reading

FDA Eyeing Oversight of Some Medical Mobile Apps

The US Food and Drug Administration is seeking comments regarding its proposed oversight of some health-related mobile apps. (Image: Katharine Andriotis/

The ever-growing number of health-related software applications, or apps, for smartphones, tablets, and personal digital assistants have caught the eye of the US Food and Drug Administration (FDA). The agency announced today that is considering providing oversight of some of these mobile apps and is seeking input from the public.

It is estimated that by 2015, about 500 million smartphone users worldwide will be using a health care app.

Of interest are apps that will allow physicians to conduct patient care. Specifically, the FDA is focusing on 2 subsets of health apps that may affect the performance or function of medical devices already regulated.

One subset involves apps that are used as an accessory to a medical device already regulated by the FDA, such as an app that allows a physician to make a specific diagnosis by viewing a radiological image on a smartphone or tablet. The other subset involves apps that transform a mobile communication device attached to sensors or other equipment into a regulated medical device—for example, an app that turns a modified smartphone into an electrocardiograph, or ECG, machine to detect abnormal heart rhythms. Continue reading

Telemedicine Aids Hepatitis C Treatment in Rural Areas

Treatment for chronic hepatitis C virus infection can be as effective at rural primary care centers as at academic medical centers, according to a new study. (Image: E. H. Cook Jr/CDC)

Rural primary care centers can treat chronic hepatitis C virus (HCV) infection as effectively as academic medical centers, given the proper tools and training. A study released online today in the New England Journal of Medicine says the primary care model used in rural New Mexico could bring much-needed care to underserved populations with complex, chronic illnesses in other parts of the United States and the world.

Investigators tracked treatment success rates at 21 Extension for Community Healthcare Outcomes (ECHO) sites, which included 16 community primary care centers and 5 prisons. The University of New Mexico Health Sciences Center in Albuquerque launched the program in 2003 to improve access to care for HCV infection and to study treatment outcomes. The model uses video and telephone conferences to link community health professionals with specialists at the university for discussions of patients’ cases and brief teaching sessions. Continue reading

Internet May Replace Need for Outpatient Rehab After Total Knee Replacement

Patients who have undergone total knee replacement may be able to undertake rehabilitation therapy at home via an Internet-connected computer. Image: Gary Martin/

Patients who have undergone total knee replacement may be able to receive rehabilitation therapy at home via their Internet-connected home computer, allowing them to skip the trips to an outpatient physical therapy department.

Researchers from Brisbane, Australia, found that patients receiving a 6-week program of outpatient physical therapy either through the conventional manner or by means of an Internet-based telerehabilitation program had similar significant improvements in flexion and extension range of motion, muscle strength, limb girth, pain, and quality of life. The study was published online yesterday in the Journal of Bone and Joint Surgery. Continue reading