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Increasing online access to healthcare ramps up demand, study finds

Government plans to increase online access to medical records and e-consultations will push up demands on clinicians and increase costs, a study suggests.

Users of online access had a significant increase in consultations, out of hours visits, trips to the emergency department and hospital admissions, analysis of data from an online access system used by US healthcare organisation Kaiser Permanente showed.

The researchers concluded that, contrary to current thinking, online services do not cut the need to see the doctor.

The study compiled data from almost 159,000 patients and compared health care use by those who used MyHealthManager with those who did not. It showed that patients who had electronic access to their medical records, test results and the ability to email their doctor had an average 0.7 extra clinic visits a year after they signed up.

Telephone consultations went up by 0.3 per patient per year and out of hours visits rose by 19 per 1,000 patients.

Trips to the emergency department also went up by 11 per 1,000 patients per year and there were 20 more hospital admissions a year for every 1,000 people signed up to the online service.

Writing in the Journal of the American Medical Association, the researchers said the increase could have been due to online access increasing health concerns, or that people signed up in anticipation of getting help for a health problem.

But they also added patients may use the technology to gain more frequent access to clinicians rather than a substitute for healthcare contact.

‘If these findings are evident in other systems, health care delivery planners and administrators will need to consider how to allocate resources to deal with increased use of clinical services’ they concluded.

A separate UK study, the Cochrane review on email, found there was no evidence to support the increased use of email in healthcare.

The studies come just a week after the government announced a commitment for all patients to be able to email their GP practice by 2015 and plans to expand e-consultations by GPs. Radical plans are also in place to dramatically expand online access to patient records.

Dr Paul Cundy, chairman of the joint GPC and RCGP IT committee, said the figures in the American study were ‘a disaster’.

The GPC had already raised concerns over increased workload, he said.

‘In the US there is a positive disincentive to seeking healthcare because they have to pay but this shows it still resulted in more consultations.

‘In the UK system, it is highly likely the effect will be even greater… there is no capacity in general practice for additional work from the IT literate, worried well.’

Dr Brian Fisher, a GP in south-east London, said he would not recommend communicating by email as it is insecure, but to use secure messaging instead.
He said: ‘There is evidence if you combine messaging and patients having access to their records you can save time, telephone calls and appointments… It is a synchronous communication so fairly easy to manage.’

An NHS Commissioning Board spokesperson said patient online access to their GP records is a priority.


Readers' comments (15)

  • Online consultations are a joke. If we had to offer them I would simply have a standard reply saying ' come to the surgery and make an appointment'

    Mind you it won't be with me because I am taking early retirement in 92 days time.

    Good luck.

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  • "An NHS Commissioning Board spokesperson said patient online access to their GP records is a priority" - no matter what damage it causes to General Practice in the meantime?? I hope they see sense and I hope the RCGP can take note of this study findings, as they are currently advising the NHSCB on implementation

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  • Let common sense prevail

    Increasing accessibility is a lovely political issue isn't it, but have we learnt nothing from NHS Direct, where easier access has cost a fortune for little benefit? Is it really sensible to dismantle a failing national service (NHS Direct) and then rebuild a smaller version in every surgery throughout the land?

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  • Harry Longman

    This report must be a concern for those rushing to a technology solution to the problems of access and resource use. What our GPs find with the Patient Access method is that while contacts may go up initially where there was unmet need, they then decline a little as access and continuity improve patient care. Further, better efficiency means that doctor time is saved. The difference being service led not technology led.

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  • I'm sure the headline in the 60s the headlines read:

    "Free NHS care ramps up demand, study finds"

    Truth is, if you offer a free service and make it more accessible, the demand will increase. It's not a rocket science!

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  • This study doesn't analyse the content or validity of the increased consultation events.

    For example, a clinician orders blood tests and fails to notice a significantly abnormal result. Due to this oversight, no action is taken and the patient is not informed.

    A patient with access to their own results can identify the significantly abnormal result and follow it up with the clinician.

    A patient without access to their own results would be none the wiser and would continue to suffer unknowingly.

    More in-depth analysis is needed before simple conclusions are drawn.

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  • What? That makes no sense. Would the patient be able to interpret the result anyway? If they were suffering, how would it be 'unknowingly', and if they were suffering wouldn't they follow up anyway?

    Try my scenario:

    Out of the hundreds of tests that we order, there are often minor (trivial) abnormalities. E.g. An LFT result a tiny bit elevated, or a WCC of 7.1. The doctor interprets these as 'not significant' in the context of the clinical presentation but the patient, not having the knowledge to interpret these results, notices over the weekend that something is 'out of range' and panics until monday morning when an extra consultation is generated. Repeat over and over for many tests.

    Which scenario do you think is more likely?

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  • @Anonymous 1:12pm

    I'm talking about significant abnormalities. And why do you automatically assume patients can't interpret their own results?

    Some patients with LTCs are better informed about their LTCs than their clinicians and therefore prefer to track their own results instead of relying on a clinician who may or may not pick up on the abnormal result (presumably due to overwork, holidays or absences or other pressures on their time).

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  • Ahh but there's the rub - you have to have a bit of knowledge to know what 'significantly abnormal is'. A potassium of 7 - i.e. '2' above the normal range - significant. A CRP of 7 (2 above the normal range for our lab) - unlikely to be significant.

    I'm aware that *some* patients with LTCs can interpret their results, but most patients (especially those who do not have LTCs) do not have the background or experience to do this.

    If you're a clinician you must be aware how many FBCs come with minor abnormalities in the 'less important' minor indices. Again, do you really think your scenario (which is somewhat far fetched and relies on clinicians making errors) is more likely to be than the common one that I suggest?

    You make an argument for better checking and systems to deal with holiday leave etc but this doesn't necessarily translate to all patients having direct access to unfiltered results. Patients are welcome to have a copy of their results - all they have to do is ask.

    Any perceptible gain in this marginal area might well be swamped by the decreased availability due to the increased workload generated by this. The results of the American study above are worrying (it's big enough to be taken seriously) and should give DOH pause for though (although it won't).

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  • Vinci Ho

    E-consultation is similiar to on telephone and is really only suitable for some problems . The basis of medicine is - look , listen , question ( i.e. history AND examination) and then make diagnosis. The mechanism is interactive . Not all people understand that . The fact on line is very convinient does not warrant 'selling' consultations like commercial products electronically . Once again , politicians like to say 'patients are customers and customers are always right '......

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