• Ted E Palen, Colleen Ross, J David Powers, and Stanley Xu.
• Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave, Ste 300, Denver, CO 80231, USA. ted.e.palen@kp.org
• JAMA. 2012 Nov 21;308(19):2012-9.

ContextPrior studies suggest that providing patients with online access to health records and e-mail communication with physicians may substitute for traditional health care services.ObjectiveTo assess health care utilization by both users and nonusers of online access to health records before and after initiation of MyHealthManager (MHM), a patient online access system.Design, Setting, And ParticipantsRetrospective cohort study of the use of health care services by members (≥18 years old) who were continuously enrolled for at least 24 months during the study period March 2005 through June 2010 in Kaiser Permanente Colorado, a group model, integrated health care delivery system. Propensity scores (using age, sex, utilization frequencies, and chronic illnesses) were used for cohort matching. Unadjusted utilization rates were calculated for both MHM users and nonusers and were the basis for difference-of-differences analyses. We also used generalized estimating equations to compare the adjusted rates of utilization of health care services before and after online access.Main Outcome MeasuresRates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters, and hospitalizations between members with and without online access.ResultsComparing the unadjusted rates for use of clinical services before and after the index date between the matched cohorts, there was a significant increase in the per-member rates of office visits (0.7 per member per year; 95% CI, 0.6-0.7; P < .001) and telephone encounters (0.3 per member per year; 95% CI, 0.2-0.3; P < .001). There was also a significant increase in per-1000-member rates of after-hours clinic visits (18.7 per 1000 members per year; 95% CI, 12.8-24.3; P < .001), emergency department encounters (11.2 per 1000 members per year; 95% CI, 2.6-19.7; P = .01), and hospitalizations (19.9 per 1000 members per year; 95% CI, 14.6-25.3; P < .001) for MHM users vs nonusers.ConclusionHaving online access to medical records and clinicians was associated with increased use of clinical services compared with group members who did not have online access.

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