title: Virtualized healthcare delivery: understanding users and their usage patterns of online medical consultations.
abstract: BACKGROUND
  Virtualization of healthcare delivery via patient portals has facilitated the increasing interest in online medical consultations due to its benefits such as improved convenience and flexibility, lower cost, and time savings. Despite this growing interest, adoption by both consumers and providers has been slow, and little is known about users and their usage and adoption patterns.
  
  
  OBJECTIVE
  To learn characteristics of online healthcare consumers and understand their patterns of adoption and usage of online clinical consultation services (or eVisits delivered via the portal) such as adoption time for portal users, whether adoption hazard changes over time, and what factors influence patients to become early/late adopters.
  
  
  METHODS
  Using online medical consultation records between April 1, 2009 and May 31, 2010 from four ambulatory practices affiliated with a major healthcare provider, we conduct simple descriptive analysis to understand the users of online clinical consults and their usage patterns. Multilevel Logit regression is employed to measure the effect of patient and primary care provider characteristics on the likelihood of eVisit adoption by the patient, and survival analysis and Ordered Logit regression are applied to study eVisit adoption patterns that delineate elements describing early or late adopters.
  
  
  RESULTS
  On average, eVisit adopters are younger and predominantly female. Their primary care providers participate in the eVisit service, highlighting the importance of physician's role in encouraging patients to utilize the service. Patients who are familiar with the patient portal are more likely to use the service, as are patients with more complex health issues. Younger and female patients have higher adoption hazard, but gender does not affect the decision of adopting early vs. late. These adopters also access the patient portal more frequently before adoption, indicating that they are potentially more involved in managing their health. The majority of eVisits are submitted during business hours, with female physicians responding faster (from submission to reply), on average.
  
  
  CONCLUSIONS
  This study addresses virtualization of primary care delivery via patient portals and online clinical consultations and examines factors that distinguish eVisit adopters from patient portal users. Among many delineating characteristics, it is particularly significant that familiarity with the patient portal service and participation of primary care provider are found to be key elements that motivate patients to become an eVisit user and early/late adopter. These findings can be used by provider organizations to design and implement strategies to improve uptake of online medical consultations to complement traditional office visits. Offering such alternative channels of care delivery may potentially improve access, efficiency and outcomes for both patients and providers alike.
authors.affiliation: Johns Hopkins University, Baltimore, MD 21202, USA. Electronic address: changmi@jhu.edu.
authors.forename: Changmi
authors.initials: C
authors.lastname: Jung
authors.affiliation: Carnegie Mellon University, Pittsburgh, PA 15213, USA.
authors.forename: Rema
authors.initials: R
authors.lastname: Padman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods* / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D033283:Patient Access to Records; D010865:Pilot Projects; D017216:Telemedicine / Q000706:statistics & numerical data*; D014584:User-Computer Interface; D055815:Young Adult
keywords: Online medical consultation; Patient portal; Usage patterns; User characteristics; Virtualized healthcare; eVisit service