The Impact of an Electronic Portal on Patient Encounters in Primary Care: An Interrupted Time-Series Analysis (Preprint)

BACKGROUND Electronic patient portals are online applications that allow patients access to their own health information, a form of asynchronous virtual care. The long-term impact of portals on the usage of traditional primary care services is unclear, but is an important question at this juncture when portals are being incorporated into many primary care practices. OBJECTIVE We sought to investigate how an electronic patient portal affects traditional, synchronous, primary care health care usage over a much longer time period than any existing studies, and to assess the impact of portal messaging on the clinician’s workload. METHODS We conducted a propensity-score-matched, open-cohort interrupted time series evaluation of a primary care portal from its implementation in 2010. We extracted information from the EMR regarding age, sex, education, income, family health team enrolment, diagnoses at index date, and number of medications prescribed in the previous year. We also extracted the annual number of encounters for up to 8 years pre and post index date as well as provider time spent on secure messaging through the portal. RESULTS 7247 eligible portal patients and 7647 eligible potential controls were identified, with 3696 patients matched one to one. We found that portal registration was associated with an increase in the number of certain traditional encounters over the time period surrounding portal registration. Following the index year, there was a significant jump in visits to physicians in the portal arm (0.42 higher than control, P<0.001) but not for visits to nurse practitioners and physician assistants. The calls to the practice triage nurses also showed a greater increase the portal arm compared to the control arm after the index year (an additional 0.102, P=0.0056). The average provider time spent on portal-related work was 5.7 minutes per patient per year. CONCLUSIONS We found that portal registration was associated with a subsequent increase in the number of some traditional encounters and a small increase in clerical workload for providers. Portals have enormous potential to truly engage patients as partners in their own health care, but their impact on usage of traditional health care services and clerical burden must also be considered when they are incorporated into primary care.