Patient access to an electronic health record with secure messaging: impact on primary care utilization

Am J Manag Care. 2007 Jul;13(7):418-24.


Objective: To determine whether patient access to secure patient-physician messaging affects annual adult primary care office visit and documented telephone contact rates.

Study design: Retrospective cohort and matched-control studies with pre-post analysis.

Methods: The cohort study sample included 4686 adult members of Kaiser Permanente Northwest (KPNW) who had been registered KP HealthConnect Online users longer than 13 months and had used at least 1 feature. The matched-control study sample included 3201 randomly selected controls matched by age/sex, selected chronic conditions, and primary care physician to 3201 registered users. We calculated the difference in primary care office visit and documented telephone contact rates in the pre- and post-periods (defined, respectively, as 3-14 months before and 2-13 months after registration for KP HealthConnect Online). Paired t tests were used to assess significance.

Results: Annual office visit rates decreased by 0.23 (-9.7%) visits per member in the cohort study. Annual office visit rates for users in the matched-control study decreased by 0.25 (-10.3%); the corresponding decrease for the controls was 0.08 (-3.7%). This 0.17 (-6.7%) reduction was significant (P < .003). Annual documented telephone contact rates for users in the matched-control design increased by 0.32 (16.2%) contacts per member; the corresponding rate for the control group was 0.52 (29.9%). This 0.20 (13.7%) difference was significant (P < .01).

Conclusion: Patient access to the secure messaging feature of KP HealthConnect Online was associated with decreased rates of primary care office visits and telephone contacts.

MeSH terms

  • Adult
  • Aged
  • Computer Security
  • Efficiency, Organizational*
  • Electronic Mail* / statistics & numerical data
  • Female
  • Humans
  • Male
  • Managed Care Programs / organization & administration
  • Matched-Pair Analysis
  • Medical Records Systems, Computerized*
  • Middle Aged
  • Office Visits / statistics & numerical data
  • Patient Access to Records*
  • Primary Health Care / statistics & numerical data*
  • Retrospective Studies
  • Telephone / statistics & numerical data
  • United States