title: Do Patients Who Access Clinical Information on Patient Internet Portals Have More Primary Care Visits?
abstract: BACKGROUND
  As health care costs alarm the nation and the debate increases about the impact of health information technologies, patients are reviewing their medical records increasingly through secure Internet portals. Important questions remain about the impact of portal use on office visits.
  
  
  OBJECTIVE
  To evaluate whether use of patient Internet portals to access records is associated with increased primary care utilization.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Primary care patients registered on patient Internet portals, within an integrated health system serving rural Pennsylvania and an academic medical center in Boston.
  
  
  METHODS
  Frequency of "clinical portal use" (days/2 mo intervals over 2 y) included secure messaging about clinical issues and viewing laboratory and radiology findings. In year 2, a subset of patients also gained access to their primary care doctor's visit notes. The main outcome was number of primary care office visits.
  
  
  RESULTS
  In the first 2 months of the 2-year period, 14% of 44,951 primary care patients engaged in clinical portal use 2 or more days per month, 31% did so 1 day per month, and the remainder had no clinical portal use. Overall, adjusted for age, sex, and chronic conditions, clinical portal use was not associated with subsequent office visits. Fewer than 0.1% of patients engaged in high levels of clinical portal use (31 or more login days in 2 mo) that were associated with 1 or more additional visits in the subsequent 2 months (months 3 and 4). However, the reverse was true: office visits led to subsequent clinical portal use. Similar trends were observed among patients with or without access to visit notes.
  
  
  CONCLUSIONS
  Patients turn to their portals following visits, but clinical portal use does not contribute to an increase in primary care visits.
authors.affiliation: *Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center†Department of Medicine, Harvard Medical School‡College of Nursing and Health Sciences, University of Massachusetts, Boston, MA§University of Washington School of Medicine∥Harborview Medical Center, Seattle, WA¶Geisinger Health System, Danville, PA#Group Health Research Institute, Group Health Cooperative, Seattle, WA.
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Leveille
authors.forename: Roanne
authors.initials: R
authors.lastname: Mejilla
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.forename: Alan
authors.initials: A
authors.lastname: Fossa
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.forename: Jonathan
authors.initials: J
authors.lastname: Darer
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: Tom
authors.initials: T
authors.lastname: Delbanco
authors.forename: Jan
authors.initials: J
authors.lastname: Walker
mesh_terms: D000328:Adult; D001900:Boston; D015331:Cohort Studies; D054626:Consumer Health Information / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D033283:Patient Access to Records; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D055815:Young Adult