Online portal leads patients back to doctors’ offices

Patients who communicate with doctors and access medical records through online portals are more engaged with their overall health care. And that connection could lead them to visit their physicians more often.

“You may have to incorporate more appointments into a busy practice,” said Ted E. Palen, MD, PhD, MSPH, an internist with Kaiser Permanente Colorado and a researcher with the integrated managed care organization’s Institute for Health Research in Denver.

Dr. Palen and fellow researchers documented the potential to increase patient visits with greater engagement in a study in the Nov. 21 Journal of the American Medical Association. They analyzed data on 87,206 Kaiser Permanente Colorado members who had access to their medical records and physicians through an online portal in an electronic health records system. Researchers compared these members with 71,663 patients of a similar age and health status who did not have access to an online portal during a one-year period.

Patients with online access had an average of 0.7 more office visits and 0.3 more telephone encounters per year. For a physician with 1,000 patients using an online portal, that translates to 10 more clinic visits and 5.5 more phone calls per week.

“I would not say you should be afraid of patient portals, but you need to be aware of the potential for a new dynamic relationship between you and your patients,” Dr. Palen said. “I don’t think these are going to go away anytime soon. We need to plan how to best use them.”

Previous research found that patient portals reduced face-to-face contact between physicians and patients. But the authors of the JAMA study say people using an online portal may have identified additional health concerns, along with preventive health requirements, and received more services.

“Online access could be a marker for patient engagement,” said Dr. Palen, lead author of the study. “These patients could be more engaged with their health care, which could be a good thing.”

Discerning the impact of patient portals and the potential increase in patient engagement is important, because practices seeking to qualify for stage 2 meaningful use bonuses must have a patient portal and 5% of patients using it. Some health systems hope that portals will improve care and enable them to qualify for insurer bonuses in an accountable care organization, a patient-centered medical home or another innovative payment model.

“Medicine is changing,” said Julio Silva, MD, MPH, chief medical information officer at Rush University Medical Center in Chicago, who is overseeing the rollout of his institution’s patient portal. “And patient engagement is a more important issue. The more we provide access, the more patients will be engaged, and the more likely they will participate in their health care and the health care delivery process. This also means they will be more likely to be compliant and more likely to ask questions.”

Not every patient wants online access

Researchers say the potential increase in health care utilization does not necessarily mean physicians who launch a patient portal will be swamped. Not every patient is willing or able to use an online portal, and physicians should think about their demographics before trying to predict the impact, say health care information technology analysts.

A survey released in October 2011 by Manhattan Research said 56 million patients accessed medical records through physician EHR systems, and 41 million would like to do so. The survey said 140 million had not used portals and were not interested in using them.

As of September, 81% of Americans had used the Internet, but use varied by age, according to the Pew Research Center. Ninety-five percent of people age 18 to 29 are online, but only 52% of seniors are.

That discrepancy may translate into less patient use depending on the practice. Carlos A. Labrador, MD, a solo practice family physician in St. Petersburg, Fla., has had a patient portal for about two years. But he hasn’t had many patients, most of whom are seniors, sign up.

“Some young patients like it, but a lot of the older patients are not completely comfortable,” he said.

Practices with patient portals say additional appointments can be balanced with time saved not having to play phone tag with patients. Other aspects of portals can make visits shorter and more efficient. For example, patients who leave a visit without copies of records or instructions for follow-up can look up that information online.

“We save a lot of phone calls and a lot of nursing time,” said James Keegan, MD, CEO of Regional Health Physicians and chief medical officer of Regional Health, a large health system based in Rapid City, S.D. The system has had a patient portal for about 10 months, and 15,000 patients have signed up. “Test results can be communicated in a convenient fashion, and we can provide patient education through the portal.”