July 19, 2007

Patient Access to an Electronic Health Record (EHR) With Secure Messaging: Impact on Primary Care Utilization” from the July issue of American Journal of Managed Care is self-described as “the largest study to date of the impact of access to secure patient–physician messaging on provider workload.” This retrospective study was conducted from 2002-2005 at the nonprofit managed care Kaiser Permanente Northwest (KPNW). It looked at nearly 4700 patients who were already active enrollees in HealthConnect Online service (which provides patient access to limited sections of their EHR and secure emailing) with 3200 of them also matched by age, sex, selected chronic conditions and primary care physician to a control group. They found a 6.7% drop in office visits (p<0.003), and almost 14% drop in phone calls (p<0.01) among HealthConnect Online participants as compared to controls. The authors conclude that, “Electronic messaging may provide a solution to pervasive efficiency and access issues for both patients and providers.” There is no mention of resultant changes in quality of care other than this taste: “KPNW collects data for the Health Employer Data and Information Set (HEDIS) as part of routine quality surveillance. The HEDIS reports for HbA1c testing did not vary to a statistically significant degree during the years under observation,” and there is no mention of broad patient satisfaction or changes in physician income. Modern Healthcare made this observation in their writeup: “Naturally, because Kaiser is an integrated delivery network, officials there can look upon technology driving a near-10% drop in office visits with far more equanimity than a fee-for-service physician group leader would.”

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