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Do Patients Who Access Clinical Information on Patient Internet Portals Have More Primary Care Visits?

Leveille, Suzanne G., PhD, RN*,†,‡; Mejilla, Roanne, MS*; Ngo, Long, PhD*,†; Fossa, Alan, MPH*; Elmore, Joann G., MD, MPH§,∥; Darer, Jonathan, MD, MPH; Ralston, James D., MD, MPH§,#; Delbanco, Tom, MD*,†; Walker, Jan, RN, MBA*,†

doi: 10.1097/MLR.0000000000000442
Original Articles

Background: As health care costs alarm the nation and the debate increases about the impact of health information technologies, patients are reviewing their medical records increasingly through secure Internet portals. Important questions remain about the impact of portal use on office visits.

Objective: To evaluate whether use of patient Internet portals to access records is associated with increased primary care utilization.

Research Design: A prospective cohort study.

Subjects: Primary care patients registered on patient Internet portals, within an integrated health system serving rural Pennsylvania and an academic medical center in Boston.

Measures: Frequency of “clinical portal use” (days/2 mo intervals over 2 y) included secure messaging about clinical issues and viewing laboratory and radiology findings. In year 2, a subset of patients also gained access to their primary care doctor’s visit notes. The main outcome was number of primary care office visits.

Results: In the first 2 months of the 2-year period, 14% of 44,951 primary care patients engaged in clinical portal use 2 or more days per month, 31% did so 1 day per month, and the remainder had no clinical portal use. Overall, adjusted for age, sex, and chronic conditions, clinical portal use was not associated with subsequent office visits. Fewer than 0.1% of patients engaged in high levels of clinical portal use (31 or more login days in 2 mo) that were associated with 1 or more additional visits in the subsequent 2 months (months 3 and 4). However, the reverse was true: office visits led to subsequent clinical portal use. Similar trends were observed among patients with or without access to visit notes.

Conclusions: Patients turn to their portals following visits, but clinical portal use does not contribute to an increase in primary care visits.

*Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center

Department of Medicine, Harvard Medical School

College of Nursing and Health Sciences, University of Massachusetts, Boston, MA

§University of Washington School of Medicine

Harborview Medical Center, Seattle, WA

Geisinger Health System, Danville, PA

#Group Health Research Institute, Group Health Cooperative, Seattle, WA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Supported by the OpenNotes Project, funded by Robert Wood Johnson Foundation grants 65921 and 71082. T.D. and J.W. were also supported by the Drane Family Fund, and the Richard and Florence Koplow Charitable Foundation.

OpenNotes is not a software program. OpenNotes is an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians.

The authors declare no conflict of interest.

Reprints: Suzanne G. Leveille, PhD, RN, College of Nursing and Health Sciences, University of Massachusetts, 100 Morrissey Boulevard, Boston, MA 02125-3393. E-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.