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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.