Online access associated with uptick in doctor visits

Patient online access to doctors and medical records was associated with increased use of almost all in-person and telephone medical services, according to a study published Tuesday in the Journal of the American Medical Association.

Those services included doctor appointments, telephone consults, after-hours clinic visits, emergency room visits and hospitalizations.

Dr. Ted Palen and his team looked at members of Kaiser Permanente Colorado, an integrated health system with more 500,000 members that includes an online patient portal known as MyHealthManager (MHM).

Palen and his team are all affiliated with Kaiser Permanente Colorado. They set out to learn more about the use of electronic medical records and their association to the amount of health care services patients use when they have online access to their health care.

The study hypothesis was that access to MyHealthManager would lead to a decrease in in-person health care services, a common theory posed by supporters of electronic medical records and shown in previous studies.

"That was what was surprising to us," says Palen, a clinician researcher at Kaiser Permanente's Institute for Health Research and the study's lead author. "This association seemed to be true across all visits and true for older users and younger users."

Palen and his team had a large cohort of 44,321 MyHealthManager users compared to 44,321 non-users. All the participants were at least 18 years old and were enrolled in Kaiser Permanente Colorado for at least two years between March 2005 and June 2010. Palen and his team matched the participants on their age, gender, and their diagnoses of at least one of four chronic conditions: congestive heart failure, coronary artery disease, diabetes and asthma.

Online access to MyHealthManager was defined as members who had activated an MHM account, kept it active for at least one year, and used at least one feature on the site. The researchers did not gather data on which features the patients used.

The findings raise questions about what's driving the association, particularly because the results contradict the common wisdom that online access to health records and doctors will ultimately lead to fewer in-person visits.

"It puts the onus on us and a lot of other researchers to delve in to this further, to really peel away the layers of the onion to find out exactly what is going on and get a better understanding," Palen says.

Understanding is key, because online access to health care and medical records isn't going away, he says.

"The horse is out of the barn on this thing," he says. "Electronic personal health records are out there. People enjoy using them."