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).

Ted E. Palen, MD, PhD, MSPH, lead author of the study, discussed the findings with news@JAMA.

news@JAMA: Were you surprised by the findings?

Dr Palen: We were surprised. An earlier study by Kaiser with fewer patients found a decrease in demand for office visits.

This study was retrospective, so it was only an association between online access and service use. This study raised a lot of questions. We plan to interview patients about the use of this tool and its impact on in-person utilization. We have several hypotheses we will try to investigate going forward. Patients may have signed up for MyHealthManager because they anticipated the need for coming health care. Another hypothesis is that even though we tried to match online users and nonusers, there is the potential for uncontrolled confounders; maybe these patients were actually sicker and needed more services. Another hypothesis is that as our providers and patients are maturing in how to use these tools, providers are recognizing that patients need to be seen more often.

news@JAMA: What are the implications of your findings for efforts to roll out more electronic access to health records and services?

Dr Palen: Electronic access is here to stay and it’s more than just e-mail access. There are a lot of tools patients have access to. We may learn to use them better. As we go forward, we want to focus on how to optimize the use of these tools by physicians and patients. At Kaiser, we are an integrated model; we want to use electronic technologies to provide better care, improve access, and improve patient outcomes.

I know my patients really enjoy having this access. I was seeing a patient in the clinic and when I returned to the exam room after looking up her results, she had already downloaded and seen her results using her phone. It reframed the discussion to the treatment plan and what to do next. So it’s learning how to use these tools to partner with patients on how to improve care.

news@JAMA: There is much hope that technological advances may help bend the cost curve, but so far the evidence hasn’t always supported that. Do you think e-tech will help with health care costs?

Dr Palen: Our study wasn’t designed to look at cost. We hope to look at cost in future studies. I can speculate on what effect electronic tools may have on cost. In my experience, I feel more efficient at delivering care and better at integrating care for a larger group of patients. We know more patients are coming as the population ages, and there will be fewer physicians to serve them. Tools like this are going to be important to efficiently deal with health care demand in the near- and long-term future.

news@JAMA: Are there other potential benefits of patients’ increasing use of online portals?

Dr Palen: Another part of our research is investigating whether this improves health outcomes in the long run. We know that treating blood pressure and diabetes decreases heart disease and stroke risk in the long term. The question is what happens in 2 to 3 years. Is it a short-term increase in clinical services that may reduce cost and utilization in the long run?

news@JAMA: What do you think is the main take-home message of your results?

Dr Palen: We have lots of patients using these tools. In the Kaiser Colorado system, more than 60% of patients have signed up with MyHealthManager. We need to understand how best to use these tools. We saw increased use of health services, but we don’t know if this increased use is good, bad, or indifferent.

Categories: Health Policy, Informatics/Internet in Medicine, Quality of Care, Telemedicine