Online access leads to increased usage

A US study has found that patients with online access to their health records and email communication with their doctors use significantly more health services than those without access.

The study, published in the Journal of the American Medical Association, assessed health care utilisation by users and nonusers of Kaiser Permanete’s online patient access system, MyHealthManager.

MHM, introduced in 2006, gives people secure online access to their health records, including test results. Patients can book or cancel non-urgent appointments, request medication refills, and send and receive messages from clinicians.

Member use of online access steadily increased from about 25% at the end of 2007 to 54% by June 2009 and more than 45% of members with MHM access used at least one function.

Each cohort in the study had around 45,000 members who were continuously enrolled for two years.

Data on the patients’ health service usage was pulled from their electronic medical records for the year before and after activating their MHM account.

The analysis found an increase in rates of office visits of 0.7 per year for those who signed up for MHM access. They had an increase of 0.3 for telephone conversations as well as significant increases in rates of out-of-hours visits, emergency department visits and hospitalisations.

In contrast, those without access decreased their number of office visits per year.

The report said that in a health system with 100,000 adult members with online access, the study would suggest that over one year the health system would need to provide more than 50,000 more clinic visits and respond to 30,000 more telephone calls.

“If this also holds true for a small group practice, a primary care physician with 1000 adult patients who have online access would need to provide for almost 10 more clinic visits per week and over 5.5 more telephone calls per week,” the report said.

The different usage patterns were consistent between users and non-users suffering from long-term conditions such as asthma and diabetes.

Asthmatics who were MHM users had significantly increased rates of office visits compared with their pre-MHM usage period. Rates of hospitalisation also increased to 95.7 per 1000 members per year compared to 56.4 in the pre-MHM usage period and 43.6 for non-users.

The report’s authors said there are several possible explanations for these findings.

Additional health issues may be identified through online access necessitating higher usage or patients 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,” the report explained.

While previous studies had indicated that online access for patients could in some cases be used to reduce face-to-face interactions, this study showed the situation is much more complex.

“Our findings suggest that the relationship between online access and utilization is more complex than the simple substitution of online for in-person care suggested by earlier studies.

“If these findings are evident in other systems, health care delivery planners and administrators will need to consider how to allocate resources to deal with increased use of clinical services,” the report concludes.

“As online applications become more widespread, health care delivery systems will need to develop methodologies that effectively integrate health information technologies with in-person care.”