Do Patient Portals Ramp Up Cost Of Healthcare?

Patients who had access to their online records and who may have taken advantage of other features on a patient portal used the healthcare system more than those who didn't participate in the portal, according to a study by researchers at Kaiser Permanente.

While this could drive up costs in the short term, more research will have to be done to determine whether or not portal users will see long-term health benefits from increased use of the system, said Ted Palen, MD, of the Institute for Health Research at Kaiser Permanente and the study's lead author, in an interview with InformationWeek Healthcare.

Some previous studies have suggested that if patients can look up test results, confer with providers, and request prescription refills online, they will call physician offices less and make fewer office visits. So the results of the new Kaiser study, published in the Journal of the American Medical Association, surprised the researchers, Palen said.

The study compared 44,321 Kaiser Permanente Colorado members who signed up for the portal between 2006 and 2009 and remained active members for at least a year with a matched group who did not enroll in the portal. The matching included gender, age, ethnicity, and whether or not the patients in the two groups had asthma, coronary artery disease, diabetes, or congestive heart failure.

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Portal participants could not only see portions of their electronic health record, but they could also request prescription renewals and appointments and exchange secure e-mail messages with their providers.

The researchers found that, after adjusting for changes in average utilization by non-portal participants during the study period, patients who used the portal had 0.7 more physician office visits per member annually; 0.3 more phone calls to clinicians per member annually; 19.9 more hospitalizations per 1,000 members annually; 18.7 more after-hours clinic visits per 1,000 members annually; and 11.2 more ED visits per 1,000 members annually.

Palen said it's possible that portal participants might have been more concerned about their health than those who didn't sign up for the portal, which would account for some of the difference in their use of the healthcare system. If patients became more engaged in their own healthcare as a result of using the portal, he noted, their health outcomes might improve in the long run. "That's a ripe area for further exploration," he said.

The paper also hypothesized that "online access to care may have led to an increase in use of in-person services because of additional health concerns identified through online access." While calling that "pure speculation," Palen pointed out that physicians are not trained in doing online consultations with patients, and some may be uncomfortable with it. (Kaiser gives patients online access to all of their doctors, so they must respond to messages.) As a result, these clinicians might ask patients to come in rather than try to deal with their health issues online.

Also, he said, some patients might express concerns or questions online that they would not have brought up in an office visit, and that could "prompt more contact with the healthcare system down the road."

Of course, online consultations are only one potential use of the portal. At the time of the study, the researchers did not have data indicating what members were using the portal for, but they have it now and will use that in future research.

Palen told Reuters that if his study's findings were applied to a small group practice, a physician with 1000 patients who started offering online access to records might expect an additional 10 patient visits a week. In the InformationWeek Healthcare interview, he confirmed that administrators should "be prepared for the possibility that members or patients may request more office visits" and make more phone calls to practices.

But in the long term, he added, "it may be a very good thing that there's more contact with the healthcare system in that first year. It may lead to identification of healthcare issues that can be intervened on early, and two to four years down the road, that patient's health outcomes may be improved."

Similarly, David Bates, MD, a health IT expert at Brigham and Women's Hospital in Boston and coauthor of an editorial on the Kaiser study, told HealthDay that the study results should not discourage providers from using patient portals. Even if they lead to increased utilization, he said, they could also improve health.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)