Patients with Online Access to Medical Records Use More Services.

Office and emergency department visits, telephone calls, and hospitalizations all rose when online access was available and used.

Electronic health record (EHR) systems are capable of providing portals for patients to access medical records and laboratory tests, as well as to communicate with physicians by e-mail. Some studies suggest, and enthusiasts hope, that virtual visits and physician communications by e-mail will decrease need for face-to-face medical visits, improve outcomes, and lower costs.

Through an integrated healthcare system in Denver that uses a comprehensive EHR with a patient portal, researchers compared about 44,000 members who voluntarily signed up for online access to medical records and clinician e-mail with 44,000 who did not. The two groups were matched for demographics, chronic disease burden, and baseline office visits. Portal users attended an average of 0.7 more office visits and made 0.3 more telephone calls per member per year than did nonusers. All other evaluated services also were used significantly more frequently by portal users, including hospitalizations, after-hours visits, and emergency department visits, (20, 19, and 11 more per 1000 members per year, respectively).

Comment: The authors calculate that, in a primary care practice of 1000 patient-portal users, these results would translate to about 10 more office visits and 5.5 more telephone calls weekly — this increase is not trivial. Whether higher use of services translates to improved outcomes cannot be assessed from this study. Users and nonusers were not matched for healthcare-seeking behaviors and medical decision-making behaviors. Editorialists note that this is just the beginning of technological and nontraditional approaches to providing medical care; whether higher quality and lower costs can be realized is far from clear.

Source: Journal Watch General Medicine

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