Across the country, in both rural and urban settings, there is considerable interest and activity in the implementation of electronic health records (EHRs), including providing patients with access to their own electronic health records, called personal health records (PHRs). Much of this effort is being led by the Centers for Medicare and Medicaid Services (CMS) through their financial incentives to physicians to implement “meaningful use” criteria. There are different stages to meaningful use, with stage 2 involving a component related to PHRs. In our state, the Arizona Health-e Connection is assisting physicians with the adoption of health information technology and health information exchange.
One of the working premises of those involved in EHRs and PHRs is that providing additional health information to patients through their own PHRs would help patients to make more informed decisions about their healthcare and that the utilization of healthcare services would be reduced as patients consult physicians via email and do not make unnecessary office visits. A new study in the November 21st issue of JAMA casts doubt on those assumptions.
In this new study by Ted Palen and colleagues, a retrospective cohort design was used to track health care resource utilization over a five year period among users and non-users of PHRs in Kaiser Permanente Colorado. What did the researchers find? Well, to their surprise, they found that the utilization of healthcare resources (office visits, telephone encounters, and acute care) was higher among users of PHR. In the words of the authors, “In this study, we found that patients with online access to their medical records, including secure e-mail communication with clinicians, had a subsequent increase in use of most in-person and telephone clinical services, which is contrary to our expectations and the results of some prior studies.”
In the same issue of JAMA, David Bates and Susan Wells authored a commentary addressing the Palen study and the broader issues of the relationship of PHRs and healthcare utilization. They, too, try to reconcile the findings of this new study with the previous literature and call the results of the Palen study “sobering for patient portal enthusiasts.” Despite the Palen study findings, Bates and Wells maintain that “electronic access to PHRs represents an extremely powerful tool from a variety of perspectives and can help empower and engage patients.”
Should the Palen study results be supported by additional studies, there will be some serious implications for both health policy makers and for healthcare payers. With the implementation of the Affordable Care Act, there will undoubtedly be an increase in the demand for healthcare services. If that is coupled with an increase in the demand for healthcare services through the implementation of PHRs, the cost pressures on the healthcare system will be magnified all the more. These costs are in addition to the considerable costs of PHRs themselves. Thus, PHRs may well turn out to be the real fiscal cliff.