Patients with online access to their medical record, including secure email communication with clinicians, had an associated increase in use of some clinical services, according to new Kaiser Permanente research published this month in the Journal of the American Medical Association.
The study examined health records of more than 500,000 Kaiser Permanente members in Colorado between May 2005 and June 2010. The researchers looked at office visits, telephone encounters, after-hours clinic visits, emergency department encounters, and hospitalizations between members with and without online access to the health care provider’s patient portal, My Health Manager on kp.org.
While this study found an association between a patient’s use of these online tools and an increase in clinical services, it did not determine or examine the reasons behind the increase.
“Kaiser Permanente has been using an electronic health record for more than a decade. Our clinicians have become sophisticated in their use of the EHR as a tool to improve care coordination as well as the quality of care we deliver to our members,” said Ted Palen, MD, PhD, MPSH, a clinician researcher at Kaiser Permanente’s Institute for Health Research and the lead author of the study. “Our members have also become more mature in their understanding of and use of the online health care tools available to them through My Health Manager. Our future research will examine the impact of these tools on health care delivery models, patient health status, and their health outcomes.”
In the study, more than 44,000 online users were matched with 44,000 non-online users. Members with My Health Manager access had 16 percent more office visits and 8 percent more telephone calls per member per year after signing up with online access compared to their rate before they had online access. In contrast, members without access to My Health Manager had 8 percent fewer clinic visits and no change in telephone calls per member per year over the course of the study. Other clinical services increases, such as emergency department visits and inpatient stays, were associated with the use of kp.org. Similar patterns of utilization were seen for both members under and over 50 years old.
In addition, members who had asthma or diabetes and were also users of My Health Manager had significantly increased rates of office visits, 15 percent and 13 percent respectively, compared to their pre-online access rates.
“The use of patient portals is a transformative new element in the long history of health care delivery. We are seeing impacts on improved quality of care and patient loyalty. Survey results from previous research found that members and physicians believe secure email can save a visit to the clinic,” said Terhilda Garrido, vice president for health IT transformation and analytics at Kaiser Permanente. “Clearly there is so much more to learn. We look forward to digging into Colorado’s work and better understanding this new modality and its implications.”
Members were included in this study if they were over 18 years old, maintained active My Health Manager access for at least 12 months and used at least one online feature during the designated study period.
This study is part of Kaiser Permanente’s larger ongoing work to better understand how electronic health records can be used to transform care delivery for members. Previous Kaiser Permanente research published in Health Affairs in 2010 showed that secure patient-physician email messaging improves the effectiveness of care for patients with diabetes and hypertension.
Also, in a recent Kaiser Permanente study published in the Annals of Internal Medicine, researchers found that the use of electronic health records was associated with improved drug-treatment intensification, monitoring and risk-factor control among patients with diabetes.
My Health Manager is Kaiser Permanente’s personal health record, linked to its comprehensive electronic health record system, Kaiser Permanente HealthConnect®. My Health Manager users can access their health records, view lab test results, email their physicians, request prescription refills, make, change and cancel appointments for themselves and, if authorized, also for family members.
Nationally, more than four million Kaiser Permanente members are registered for My Health Manager, including more than 242,000 or 62.7 percent of members in Colorado. Use of online health tools has steadily increased among Kaiser Permanente members since they were introduced in 2005 and in Colorado since they were offered in 2006.
Additional authors on this study included Colleen Ross, MS, MPH, J. David Powers, MS Stanley Xu, PhD, from the Institute for Health Research, Kaiser Permanente Colorado Denver.