I gave a seminar at the Center for Information Technology Leadership this weekend (on web patient information and patient portals, with Patti Dykes DNSc, MA, RN, a talented nurse informaticist. The presentation is here).This made me go back and reread a set of Health Affairs articles from Kaiser from earlier this year.
Kaiser found that in Hawaii the implementation of electronic medical records, scheduled telephonic visits, and a patient portal that allowed patients to send electronic messages to their physician office led to a 26% decline in office visits over four years. There were other confounding variables, including higher copayments – but this was before the “great recession” hit, and the copay increases were modest. There was not huge patient or physician turnover during this time.
Quality measures, at least by HEDIS standards, were unchanged during this time period. Patient satisfaction was slightly improved.
The Kaiser researchers are modest in their claims of cost saving. They suggest that patients save 103 minutes by not having to visit the office (which is much less than the elapsed time lost by most of my colleagues when they see a physician), and point out that Kaiser does not have cost accounting systems that make it clear how much this effort has lowered resource use. They don't take credit for the potential saved costs of avoided lab tests, imaging, and prescription therapy based on avoided office visits.
Still – this is very impressive. Is this relevant outside of Kaiser, a large, multispecialty group tightly integrated with (and capitated by) an exclusive health plan?
Private practice fee-for-service physician offices could regard patient portals the way newspapers now regard Craigs List – which destroyed their previous business model by disrupting classified advertising. To harness the benefits of patient portals, we need more connected physicians. We also need some degree of payment reform.
