In previous postings, I’ve noted that for various reasons, doctors using EMRs are tending to bill for more E/M services. This has CMS in a bit of a tizzy, and definitely deserves attention from the industry. (See also this post about EMR and Upcoding)
Now, a study appearing in the Journal of the American Medical Association seems to have identified another vector for increased use of services. According to the study, patients with online access to medical records and clinicians consume more clinical services than those without access.
The JAMA authors drew this conclusion after studying the consumption of clinical services by members of Kaiser Permanente Colorado, a group model IDS. The Kaiser unit was studied from March 2005 through June 2010, reports Becker’s Hospital Report.
What made the Kaiser unit a good choice was that not only did it have an EMR in place, it also launched a patient portal in May 2006 allowing patients secure access to health records details such as test results, care plans and active medications.
Researchers found that members who used the MyHealthManager portal, which gave access to the EMR, had increased rates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters and hospitalizations during the study period.
I was surprised to find out that JAMA researchers generated this data, especially the ED and hospitalization rates, which seem to have to been markedly different between the two groups.
It did occur to me that perhaps the sickest patients are using the portal, or that those who aren’t using the portal aren’t very engaged in caring for their health, but such relationships are rarely that simple. Besides, the researchers did group patients by “propensity scores” which took patient age, sex, utilization frequencies and chronic illnesses, so we aren’t looking at populations that simply self-selected into the sicker and more healthy.
In any event, I’m glad I stumbled across this study and could share it with you. Knowing that these patterns exist, just in case they turn up in your health system. They’re certainly worth bearing in mind.
Perhaps patients who use EHR’s are the type that are far more actively involved in managing their health. And some of the ‘more’ services they use may be preventive, or they may deal with problems earlier on – either of which makes their medical care cheaper.