Online Access to Clinicians: Impact on Utilization

By Brian Kerrigan (Own work) [CC-BY-SA-3.0
(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

This recent article in JAMA reports on the results of a retrospective study of how online access to clinicians affects use of services.

The results are unexpected and contrary to conventional wisdom: patients with online access used substantially more services across the board including office visits, after hours advice, ED and inpatient admissions.

The study conducted by Kaiser Permanente, while subject to some limitations, is reasonably well constructed and looked at 24 months of utilization by established patients. Presumably the platform was Epic Systems patient portal MyChart.

This study throws some cold water on the current hopes that virtualization of the healthcare system will lead to decreased utilization. The thinking goes that if it is easier for patients and caregivers to connect, then simple matters will be handled "online" while those with chronic diseases will be more closely monitored and more likely to get help early when it is often easier to intervene before things escalate.

This study calls this into question.

Of course there are several potential flaws in the study - these are well described in the article. Clearly more studies are needed to validate or refute these findings.

The other, and ultimately most important question, is the overall long-term impact on clinical and financial OUTCOMES. It may be that online access leads to increased utlization that is both appropriate and ultimately more clinically effective.

If not, then we may have to rethink the use and value of online access.