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'E-Medicine' May Not Be Cost Saver After All, Study Says

By Steven Reinberg
HealthDay Reporter

TUESDAY, Nov. 20 (HealthDay News) -- Patients who can access their medical records and test results online tend to use more medical services and visit their doctor more often than before, according to a surprising new study.

It was believed that viewing health records electronically and being able to email the doctor would result in fewer office visits and phone calls -- and ultimately cut health costs -- but that wasn't the case here.

"Our hypothesis going into the study was exactly that," said lead researcher Dr. Ted Palen, a clinician researcher at Kaiser Permanente Colorado Institute for Health Research in Denver.

It's possible that the increase in medical services wasn't the result of online access, Palen said. "This was an association we found, it wasn't necessarily a cause and effect. We need to understand more about this association."

Ultimately, he speculated, online access will produce better health care and better results for patients.

For the study, published in the Nov. 21 issue of the Journal of the American Medical Association, Palen's team collected data on Kaiser Permanente members in Colorado enrolled from 2005 to 2010.

Researchers tracked office visits, telephone calls, after-hours clinic visits, emergency department visits and hospitalizations for roughly 44,000 adults with online access to their medical records and 44,000 patients without access.

They found online users had 16 percent more office visits and 8 percent more telephone calls in the year after they gained online access, compared to their rate beforehand.

Patients without online access had 8 percent fewer clinic visits and no change in telephone calls.

Asthma and diabetes patients with online access had 15 percent and 13 percent more office visits, respectively, than before. More emergency department visits and hospital stays were also associated with online access.

Why online access was associated with greater use of services wasn't clear, the researchers say. Perhaps patients sign up for online access in anticipation of the need for more services, or they may be more engaged in their health care overall, Palen said.

Dr. David Bates, senior vice president for quality and safety at Brigham and Women's Hospital in Boston, said the findings bring into question the expectation that use of clinical services will decrease as electronic health records become available, which earlier studies had suggested.

However, Bates, co-author of an accompanying journal editorial, noted that the personal health records studied lacked tools for managing chronic conditions such as diabetes and high blood pressure, which can be expected to reduce services.

Online access to medical records isn't just about saving money, it's also about improving health, Bates added.

"Patients want more information online, and as they begin using patient portals linked to their doctors' electronic health records, most will find they really like them," he added.

This study shouldn't discourage that practice, he said. "Doctors should be encouraging patients to use these portals regardless of the impact on utilization, because they are likely to improve health," Bates said.

More information

For more information on medical records, visit the U.S. Department of Health and Human Services.

SOURCES: Ted Palen, M.D., Ph.D., clinician researcher, Institute for Health Research, Kaiser Permanente, Denver; David Bates, M.D., senior vice president, quality and safety, chief quality officer, Brigham and Women's Hospital, Boston; Nov. 21, 2012, Journal of the American Medical Association

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