Research Article
No access
Published Online: 27 February 2014

Impact of Patient Portal Secure Messages and Electronic Visits on Adult Primary Care Office Visits

Publication: Telemedicine and e-Health
Volume 20, Issue Number 3

Abstract

Introduction: Secure messages and electronic visits (“e-visits”) through patient portals provide patients with alternatives to face-to-face appointments, telephone contact, letters, and e-mails. Limited information exists on how portal messaging impacts face-to-face visits in primary care. Materials and Methods: We conducted a retrospective cohort study of 2,357 primary care patients who used electronic messaging (both secure messages and e-visits) on a patient portal. Face-to-face appointment frequencies (visits/year) of each patient were calculated before and after the first message in a matched-pairs analysis. We analyzed visit frequencies with and without adjustments for a first message surge in visits, and we examined subgroups of high message utilizers and long-term users. Results: Primary care patients who sent at least one message (secure message or e-visit) had a mean of 2.43 (standard deviation [SD] 2.3) annual face-to-face visits before the first message and 2.47 (SD 2.8) after, a nonsignificant difference (p=0.45). After adjustment for a first message surge in visits, no significant visit frequency differences were observed (mean, 2.35 annual visits per patient both before and after first message; p=0.93). Subgroup analysis also showed no significant change in visit frequency for patients with higher message utilization or for those who had used the messaging feature longer. Conclusions: No significant change in face-to-face visit frequency was observed following implementation of portal messaging. Secure messaging and e-visits through a patient portal may not result in a change of adult primary care face-to-face visits.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Osborn CY, Rosenbloom ST, Stenner SP, et al. MyHealthAtVanderbilt: Policies and procedures governing patient portal functionality. J Am Med Inform Assoc 2011;18:i18–i23.
2.
Nazi KM. Veterans' voices: Use of the American Customer Satisfaction Index (ACSI) Survey to identify My HealtheVet personal health record users' characteristics, needs, and preferences. J Am Med Inform Assoc 2010;17:203–211.
3.
Wald JS. Variations in patient portal adoption in four primary care practices. AMIA Annu Symp Proc 2010;2010:837–841. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041333/ (last accessed December 10, 2013).
4.
Miller H, Vandenbosch B, Ivanov D, Black P. Determinants of personal health record use: A large population study at Cleveland Clinic. J Healthc Inf Manag 2007;21:44–48.
5.
Merrill M. Patients, referring docs at MD Anderson making good use of Web portal. Available at www.healthcareitnews.com/news/patients-referring-docs-md-anderson-making-good-use-web-portal (last accessed March 31, 2013).
6.
Roblin DW, Houston TK, Allison JJ, et al. Disparities in use of a personal health record in a managed care organization. J Am Med Inform Assoc 2009;16:683–689.
7.
North F, Hanna BK, Crane SJ, et al. Patient portal doldrums: Does an exam room promotional video during an office visit increase patient portal registrations and portal use? J Am Med Inform Assoc 2011;18:i24–i27.
8.
Gamble KH. Is it registering? Patient portals, part II (see Financial Department for part I). Healthc Inform 2009;26:24, 26, 28.
9.
Degaspari J. Getting the message, securely. Healthc Inform 2012;29:52, 54, 56 passim.
10.
Hobbs J, Wald J, Jagannath YS, et al. Opportunities to enhance patient and physician e-mail contact. Int J Med Inform 2003;70:1–9.
11.
Siteman E, Businger A, Gandhi T, et al. Clinicians recognize value of patient review of their electronic health record data. AMIA Annu Symp Proc 2006:1101. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839374/ (last accessed December 10, 2013).
12.
Kittler AF, Carlson GL, Harris C, et al. Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. Inform Primary Care 2004;12:129–138.
13.
Bergmo TS, Kummervold PE, Gammon D, Dahl LB. Electronic patient–provider communication: Will it offset office visits and telephone consultations in primary care? Int J Med Inform 2005;74:705–710.
14.
Zhou YY, Garrido T, Chin HL, et al. Patient access to an electronic health record with secure messaging: Impact on primary care utilization. Am J Manag Care 2007;13:418–424.
15.
Palen TE, Ross C, Powers JD, Xu S. Association of online patient access to clinicians and medical records with use of clinical services. JAMA 2012;308:2012–2019.
16.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373–383.
17.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.
18.
Sen B, Blackburn J, Morrisey MA, et al. Did copayment changes reduce health service utilization among CHIP enrollees? Evidence from Alabama. Health Serv Res 2012;47:1603–1620.
19.
O'Hare CD, Corlett J. The outcomes of open-access scheduling. Fam Pract Manag 2004;11:35–38.
20.
North F, Ward WJ, Varkey P, Tulledge-Scheitel SM. Should you search the Internet for information about your acute symptom? Telemed J E Health 2012;18:213–218.
21.
North F, Varkey P, Bartel GA, et al. Can an office practice telephonic response meet the needs of a pandemic? Telemed J E Health 2010;16:1012–1016.

Information & Authors

Information

Published In

cover image Telemedicine and e-Health
Telemedicine and e-Health
Volume 20Issue Number 3March 2014
Pages: 192 - 198
PubMed: 24350803

History

Published in print: March 2014
Published online: 27 February 2014
Published ahead of print: 18 December 2013
Accepted: 1 July 2013
Revision received: 27 June 2013
Received: 1 April 2013

Permissions

Request permissions for this article.

Topics

    Authors

    Affiliations

    Frederick North, MD
    Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
    Sarah J. Crane, MD
    Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
    Rajeev Chaudhry, MBBS
    Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
    Jon O. Ebbert, MD
    Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
    Karen Ytterberg, MD
    Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
    Sidna M. Tulledge-Scheitel, MD
    Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
    Robert J. Stroebel, MD
    Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.

    Notes

    Address correspondence to:Frederick North, MDPrimary Care Internal MedicineMayo Clinic200 First Street SWRochester, MN 55905E-mail: [email protected]

    Disclosure Statement

    No competing financial interests exist.

    Metrics & Citations

    Metrics

    Citations

    Export citation

    Select the format you want to export the citations of this publication.

    View Options

    Get Access

    Access content

    To read the fulltext, please use one of the options below to sign in or purchase access.

    Society Access

    If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

    Restore your content access

    Enter your email address to restore your content access:

    Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

    View options

    PDF/EPUB

    View PDF/ePub

    Full Text

    View Full Text

    Media

    Figures

    Other

    Tables

    Share

    Share

    Copy the content Link

    Share on social media

    Back to Top