Abstract
Background/Aims To compare utilization of office and telephone encounters by patients with online access to their electronic medical record (EMR) to patients without online access.
Methods Administrative data for ambulatory care patients enrolled in a group model HMO from May 2006 through June 2009, using an electronic medical record with an online patient access feature, which includes: appointment requests, results review, medication list, refill request, problem list, care instructions, and email communication with their healthcare providers. We collected administrative data for health plan utilization documented in the EMR for patients 12 months before and after the activation of their online access and for a matched cohort of patients without online access. The analytic data set included those with and without online access matched on propensity scores within a 5% range based on age, gender, and co-morbidity within baseline visit and year strata.
Results The propensity matched cohorts (N = 51,535; in each cohort) contained 54.2% females, an average age of 43.7 years, 6.9% were less than age 20, 36.2% ages 20–39, 43.3% ages 40–59, and 13.7% ages 60 and over. Eighty-six percent of the cohort had none of four chronic illnesses, 7.4% with asthma, 5.7% with diabetes, 1.5% with coronary artery disease, and 1% with congestive heart failure. In the year following activation of their on-line access, this cohort had increased rates (per patient per year) of office visits (3.1 vs. 2.2, p<0.001), telephone contacts (3.9 vs. 3.4, p<0.001), after-hour clinic visits (0.1 vs. 0.07, p<0.001), in-patient hospitalizations (0.07 vs. 0.06, p<0.01) compared to a matched cohort of patients without on-line access. However, on-line access patients had a decreased incidence rate of emergency department use (0.15 vs. 0.18, p <0.001) during the year of follow-up compared to the cohort without on-line access.
Discussion Patients with online access to their health information and to their healthcare providers also had an increased use of clinical services. Further research is needed to understand this association and to evaluate the effect online access has on patient health outcomes.
