Association of online patient access to clinicians and medical records with use of clinical services

Ted E Palen, Colleen Ross, J David Powers, Stanley Xu
JAMA: the Journal of the American Medical Association 2012 November 21, 308 (19): 2012-9

CONTEXT: Prior studies suggest that providing patients with online access to health records and e-mail communication with physicians may substitute for traditional health care services.

OBJECTIVE: To assess health care utilization by both users and nonusers of online access to health records before and after initiation of MyHealthManager (MHM), a patient online access system.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of the use of health care services by members (≥18 years old) who were continuously enrolled for at least 24 months during the study period March 2005 through June 2010 in Kaiser Permanente Colorado, a group model, integrated health care delivery system. Propensity scores (using age, sex, utilization frequencies, and chronic illnesses) were used for cohort matching. Unadjusted utilization rates were calculated for both MHM users and nonusers and were the basis for difference-of-differences analyses. We also used generalized estimating equations to compare the adjusted rates of utilization of health care services before and after online access.

MAIN OUTCOME MEASURES: Rates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters, and hospitalizations between members with and without online access.

RESULTS: Comparing the unadjusted rates for use of clinical services before and after the index date between the matched cohorts, there was a significant increase in the per-member rates of office visits (0.7 per member per year; 95% CI, 0.6-0.7; P < .001) and telephone encounters (0.3 per member per year; 95% CI, 0.2-0.3; P < .001). There was also a significant increase in per-1000-member rates of after-hours clinic visits (18.7 per 1000 members per year; 95% CI, 12.8-24.3; P < .001), emergency department encounters (11.2 per 1000 members per year; 95% CI, 2.6-19.7; P = .01), and hospitalizations (19.9 per 1000 members per year; 95% CI, 14.6-25.3; P < .001) for MHM users vs nonusers.

CONCLUSION: Having online access to medical records and clinicians was associated with increased use of clinical services compared with group members who did not have online access.

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Jonathan Lloyd

Misinterpretation of results can cause more harm than benefit


Abdul Khan

Well the issue is also that of elderly patients in rural practices. They do not want to have to do anything with EMR or access to their charts because they don't know how to use computers


Michelle Thorston

It's a no brainer. In this day and age, it doesn't make sense why all patients don't have access to this. I'll never understand why medicine is always so slow to adopt new modern day technologies.


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