Patients with online access to medical records use clinical services
5 December 2012
Patients with online access to their medical records and who
used email to communicate with clinicians used clinical services more,
including office visits and telephone encounters, compared to patients
who did not have electronic access, according to a study published in
"Using health information technology to foster efficient health
care delivery is an important component of health care reform,"
according to background information in the article. "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."
The presumption is if patients could look up health information
online such as their test results, request prescription refills,
schedule appointments, or send secure email to clinicians, their use
of clinical in-person and telephone calls may decrease. "Many
previous studies involved small numbers of patients and were
conducted early in the implementation of patient online access."
The researchers investigated the association between patient
online access and use of clinical services. The study examined the
use of healthcare services by group members (18 years of age or
older) who were continuously enrolled for at least 24 months during
the five-year study period.
Utilization rates were calculated for both users and nonusers of
My Health Manager (MHM), a patient online access system. Member use
of online access steadily increased from about 25% at the end of
2007 to 54% by June 2009 (n = 375,620). More than 45% of members
with MHM access used at least 1 MHM function. The refined groups
each contained 44,321 matched members.
The researchers found a significant increase in the per-member
rates of office visits (0.7 per member per year) and telephone
encounters (0.3 per member per year). There was also a significant
increase in rates of after-hours clinic visits (18.7/1,000 members
per year), emergency department encounters (11.2/1,000 members per
year), and hospitalizations (19.9/1,000 members per year) for MHM
users compared with nonusers. This utilization pattern was seen for
members both younger and older than 50 years." More variability was
found in rates of utilization by MHM users with chronic illnesses.
Reasons for the increase
The authors suggest several possible explanations for these
findings. "Online access to care may have led to an increase in use
of in-person services because of additional health concerns
identified through online access. Members might have activated their
online access in anticipation of health needs. Members who are
already more likely to use services may selectively sign up for
online access and then use this technology to gain even more
frequent access rather than view it as a substitute for contact with
the health care system."
"If these findings are evident in other systems, healthcare
delivery planners and administrators will need to consider how to
allocate resources to deal with increased use of clinical services.
As online applications become more widespread, healthcare delivery
systems will need to develop methodologies that effectively
integrate health information technologies with in-person care."
Palen TE, et al. Association of Online Patient Access to
Clinicians and Medical Records With Use of Clinical Services. JAMA.
2012;308(19):2034-2036. Summary available at: