Online Patient Access to their Medical Record and Health Providers is Associated with a Greater use of Clinical Services PALEN
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Online Patient Access to their Medical Record and Health Providers is Associated with a Greater use of Clinical Services PALEN

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Clinical Informatics: Using Information Technology in Health Care

Clinical Informatics: Using Information Technology in Health Care

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Online Patient Access to their Medical Record and Health Providers is Associated with a Greater use of Clinical Services PALEN Online Patient Access to their Medical Record and Health Providers is Associated with a Greater use of Clinical Services PALEN Presentation Transcript

  • HMORN 2012 session C1-04 Online Patient Access to Their Medical Record and Health Providers Is Associated with a Greater Use of Clinical Services Ted E. Palen, PhD, MD, MSPH Colleen Ross, MS, BSN Stan Xu, PhD Institute for Healthcare Research Kaiser Permanente Colorado of COLORADO
  • BACKGROUND• Studies indicate patients want online access to medical records which allow: – review test results – schedule appointments – request refills – communicate with their providers by email of COLORADO
  • BACKGROUND (cont.)• Institute of Medicine report, "Crossing the Quality Chasm: A New Health System for the 21st Century” – electronic patient–physician messaging as a promising technology to improve the quality and efficiency of healthcare• Some researchers estimate that 25-70% medical care does not require a face-to-face appointment• Department of Veterans Affairs: eHealth technologies – important model of healthcare to incorporate into clinical practice to increase access to care of COLORADO
  • BACKGROUND (cont.)• Prior studies on the impact of secure online messaging and the use of other health care services have reported conflicting results• Early MyChart experience in Kaiser Permanente patients with access to secure online messaging – decreased office visits – increased scheduled telephone contacts – compared to non-users of the service of COLORADO
  • OBJECTIVE• To investigate the impact of member online access to their health record on the use of: – office visits – telephone contacts – after hour clinic visits – emergency department use – hospitalizations• We hypothesized that as the proportion of our members using online access increased, we would experience a proportional decrease in the use of “in-person” services of COLORADO
  • METHODS• Inclusion criteria – registered MyHealthManager users (≥13 yrs) for longer than 6 months – used at least one MyHealthManager feature – were continuously enrolled as KPCO members during the study period• Study period – For the MyHealthManager user cohort • Pre-registration period was 12 months before registration date • Post-registration period was 12 months after registration date• Propensity scoring matched cohorts of non-MyHealthManager users – identify a matched cohort of non-MyHealthManager users and used the matched MyHealthManager users registration date as index date for analysis • Pre-registration period was 12 months before index date • Post-registration period was 12 months after index date• Analysis – calculate the difference in use of services between the pre- and post- periods – assess statistical significance with the generalized estimating equations of COLORADO
  • METHODS• Since implementation of the MHM in KPCO in April 2006 member use increased – 25% at end of 2006 to >50% by June of 2009 – 53.8% (375,620) as of June 2009• Initial study cohort (≥ 13 years of age) – 83,804 non-MHM users – 89,340 MHM users• Propensity score matching used to refine cohorts • Age • Gender • Race • Chronic health condition (Asthma, Diabetes, CAD, CHF) • Stratified by index year and office visits – Refined cohorts each contained 46,925 members of COLORADO
  • RESULTS 46,925 KPCO members ≥ 13 years of age non-MHM user MHM user• 52.8 % female • 53.8% female• Ave. age 42.2 years • Ave. age 43.3 years – < 20 yrs. 7.5% – < 20 yrs. 7.5% – 20-39 yrs. 37.1% – 20-39 yrs. 36.9% – 40-59 yrs. 41.8% – 40-59 yrs. 41.9% – 60+ yrs. 13.6% – 60+ yrs. 13.7%• Race • Race – White 52.1% – White 51.8% – Hispanic 11.3% – Hispanic 11.3% – Black 3.8% – Black 3.8% – Other 4.0% – Other 4.0% – Unknown 28.8% – Unknown 29.1% of COLORADO
  • RESULTS (cont.) 46,925 KPCO members ≥ 13 years of age non-MHM user MHM user• Chronic Health Conditions • Chronic Health Conditions – None 85.4% (N = 40,065) – None 85.1% (N = 39,951) – 1 13.1% (N = 6,138) – 1 13.4% (N = 6,291) – 2 1.3% (N = 615) – 2 1.3% (N = 591) – 3 0.2% (N = 100) – 3 0.2% (N = 88) – 4 0.01% (N = 7) – 4 0.01% (N = 4)• Chronic Condition • Chronic Condition – Asthma 7.8% (N = 3,677) – Asthma 7.9% (N = 3,726) – Diabetes 5.9% (N = 2,790) – Diabetes 6.0% (N = 2,834) – CAD 1.6% (N = 762) – CAD 1.6% (N = 749) – CHF 1.0% (N = 467) – CHF 0.9% (N = 444) of COLORADO
  • Encounters Before and After MyHealthManager Activation (NOTE: Activation Index Date Derived from User of MyHealthManager and Applied to Non-users 4.5 # * * Significant change within group 4.0 4.0 # Significant change between groups 3.7 3.6Encounters per 12 Months 3.5 3.5 # * 3.1 3.0 2.5 2.6 * 2.5 2.3 2.0 1.5 1.0 0.5 0.0 non-MHM User MHM User Office Visits Pre Office Visits Post Phone Contacts Pre Phone Contacts Post of COLORADO
  • Encounters Before and After MyHealthManager Activation by Age Group 6.0 * Significant change within group * *Encounters per 12 Months # 4.9 Significant change between groups # 4.9 5.0 4.5 4.3 4.0 # # * 3.5 * 3.6 3.3 3.1 * # 3.0 2.9 * 2.9 2.9 3.0 2.7 2.3 * 2.3 2.1 2.0 1.0 0.0 <50 yo non-MHM user <50 yo MHM user ≥50 yo non-MHM User ≥50 MHM User Office Visit Before Office Visit After Phone Visit Before Phone Visit After of COLORADO
  • Encounters Before and After MyHealthManager Activation by Health Condition 14.0 * Significant change within groupEncounters per 12 Months # Significant change between groups 12.0 # * 10.0 * 8.0 * * 6.0 * # # * * 4.0 # * # * * * * 2.0 0.0 No ChrDz No ChrDz Asthma non- Asthma Diabetic Diabetic CAD non- CAD MHM CHF non- CHF MHM non-MHM MHM User MHM User MHM User non-MHM MHM User MHM User User MHM User User User User Office Visits Before Office Visits After Phone Visits Before Phone Visits After of COLORADO
  • Encounters Before and After MyHealthManager Activation by Location of Service 200 * Significant change within groupEncounters per 1000 patient-yrs # Significant change between groups 182.2 181.7 180 # 160 * 150.8 140.5 140 # 120 * 100.2 100 * 88.2 84.7 # 78.6 80 * 70.8 63.2 63.6 60 50.9 40 20 0 non-MHM User MHM User After Hrs Before After Hrs After ED Visits Before ED Visits After Hosp. Before Hosp. After of COLORADO
  • Encounters Before and After MyHealthManager Activation by Age and Location of Service 200 * Significant change within group 184.7185.4 # Significant change between groupsEncounters per 1000 patient-yrs 177.8177.7 180 160 # 149.2 * 147.4 143.3 140 130.9 # 120 * 105.9 97.7 # * 100 91.9 93.4 # 90.1 * 81.9 84.1 * 81.2 80 # * 72.5 72.2 67.8 66.2 62.8 60 54.6 * 50.2 44 40 20 0 <50 yo non-MHM User <50 yo MHM User ≥50 yo non-MHM User ≥50 yo MHM User After Hrs Before After Hrs After ED Visits Before ED Visits After Hosp. Before Hosp. Afer of COLORADO
  • Encounters Before and After MyHealthManager Activation by Disease and Location of Service* 600 Encounters per 1000 patient-yrs * Significant change within group # Significant change between groups # 500 * 400 300 200 # * # * * # * # 100 * * * 0 No ChrDz No ChrDz Asthma Asthma Diabetic Diabetic CAD non- CAD MHM CHF non- CHF MHM non-MHM MHM User non-MHM MHM User non-MHM MHM User MHM User User MHM User User User User User After Hrs Before After Hrs After ED Visits Before ED Visits After Hosp. Before Hosp. After of COLORADO
  • CONCLUSIONS• MyHealthManager Users compared to non-Users – rate of utilization of office and phone visits I n c r e a s e d – 18% increase in office visits – 9% increase in phone visits – In addition, the rates of • After hours clinic visits • Emergency department visits • Hospitalizations Increa sed• This general trend was true for members: – <50 years of age and ≥50 years of age – Without chronic illnesses of COLORADO
  • CONCLUSIONS (cont.)• Incorporating online access into patient care may – highlight health concerns needing in-person evaluation• Patients might have activated their access to online services in anticipation of health needs• Patients may use this technology to – gain even better access care • rather than to substitute for other types of contact with the health care system of COLORADO
  • CONCLUSIONS (cont.)• Providing patients with online access to their medical record may actually INCREASE demand for more traditional contacts with the healthcare system to address medical issues.• Further research is needed to evaluate: – Reasons patients use online access to the healthcare services – If MHM users have different health outcomes compared to non-users – The cost/benefits of online access to healthcare services, e-visits, and clinical decision-making – The impact on the allocation of clinical resources to deal with the potential increase use of clinical service as eHealth applications become more widespread of COLORADO
  • Acknowledgements• David Ryerson, Data Specialist/SAS Programmer• J. David Powers, Biostatistician• John Steiner, MD, Dir. Institute for Healthcare Research• Cristy Geno, Project Manager• QUESTIONS???? of COLORADO