Friday, November 23, 2012

Online Communications, Surprising Results

Guess which of these images are “clickable’  No prizes awarded !





Patient/provider interaction via electronic means was predicted to be a time saver as well as a cost reducing addition to providers.

“”Healthcare futurists have viewed online communication between clinicians and patients as a welcome substitute for low-level office visits and telephone calls, lightening a clinician's load. In addition, some studies have found that virtual visits make a waiting room a little less crowded.

However, a study published in the November 21 issue of JAMA showed that letting patients email their clinician and access their records online was associated with more, not fewer, telephone calls, office visits, and clinical services in general. In this case, the substitution theory did not hold.

Lead author Ted Palen, MD, PhD, MSPH, and coauthors studied the effect of an online Web portal for patients that was deployed by Kaiser Permanente (KP) Colorado, a group model, integrated healthcare delivery system. The portal, called My Health Manager (MHM), connects to KP's electronic health record system. MHM lets patients access test results, request medicine refills, schedule non urgent appointments, and exchange messages with their clinician on non urgent health issues.

However, Dr. Palen and colleagues do not consider their research the final word on the matter, especially because it remains unclear why online access was linked to a higher rate of clinical services.

Online access, Dr. Palen told Medscape Medical News, might have helped patients take more responsibility for their healthcare, which led them to use more services. Or perhaps patients who signed up for MHM were already likely to use more services because of clinical characteristics that the study failed to control for (simply put, they were sicker). Future research will try to tease out cause and effect, he said.

The latest KP study did not control for the type of health plan. KP Colorado offers a wide gamut of plans, including traditional health maintenance organization (HMOs), high-deductible HMOs with health savings accounts, and preferred provider organization plans.

Dr. Palen said that if future research continues to find a link between patient portal use and a higher uptake of clinical services, medical organizations will need to staff accordingly. The authors estimate that if office visits for a solo practitioner with 1000 adult patients increase by just 0.5 visits per patient per year, the physician will need to book 10 more appointments each week. “”

Author’s commentary:

This study is highly biased, because it took place in the Kaiser Hospital system, a mature integrated health system. Electronic access increases availability of providers to patient.  It is also a ‘closed system’ whereby patients must use a Kaiser facility, and no other, thereby preventing a patient from going out of ‘network’ to obtain urgent care.

Dr. Palen is employed by the Colorado Permanente Medical Group. The other authors are employees of Kaiser Permanente Health Plan of Colorado. The authors have disclosed no other relevant financial relationships.

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