The doctor will e-mail you now. And then see you later.

November 24, 2012

When Ted Palen, a Kaiser Permanente researcher, started investigating what happens when doctors begin e-mailing with patients, he thought he would see the practice lighten workloads. Patients would get their questions answered remotely, with no need to turn up in person. 

Palen just finished a five-year retrospective study of what happened when Kaiser Permanente in Colorado began allowing e-mail access to doctors in 2006. The outcome, as Palen notes in this week's Journal of the American Medical Association, was "contrary to our expectations": Online access to doctors was associated with more doctor visits, not fewer.

There was a big spike in visits and phone calls to doctors' offices right when the new e-mail access, called MyHealthManager, came online. The graph below divides the Kaiser Permanente population into those who were using the online access program, and those who were not:

That initial spike did taper off with in a few months. Even a year later, however, those who utilized the online access to doctors still had higher rates of doctor visits per month. The researchers found that these patients had, on average, 0.7 more doctor visits each month and made 0.3 more phone calls than those who didn't.

There are a few possible explanations of what is happening here. One that the researchers discuss is an issue of self-selection: Those who would sign up for the online health manager might be more inclined to take a greater role in managing their own health. "Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system," the researchers write. 

There's also a possibility of the online encounters leading a patient to come in if "additional health concerns" are identified that way. An e-mail visit may beget another trip to the doctor's office, in other words, rather than prevent it.

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Ezra Klein · November 23, 2012