Now Reading: Access to a PHR constitutes highly meaningful use – published data on member retention from Kaiser Permanente

Most investigations report on adoption and the characteristics and preferences of users of online access websites or patient portals integrated with electronic health records (EHRs). Far fewer reports document the impact on outcomes of patient portals.

In 2009 I wrote a post the day after I met Regina Holliday – Is it meaningful if patients can’t use it? | Ted Eytan, MD. How nice in 2012 to find out that the data supports the right answer to this question, which is the title of this post. And in actuality, this data was being generated three years before I wrote that post in 2009, so the “meaning” has been happening for a really long time.

This paper was authored collaboratively by colleagues at Kaiser Permanente Northwest and Kaiser Permanente Health Information Technology Transformation and Analytics and looks at a specific outcome related to the use of a personal health record – health plan member retention. In the Kaiser Permanente system, it’s important to note that this is co-mingled (in a happy way) with retention and support of the patient-physician relationship. You can imagine that deciding to terminate this relationship (the term used in the health plan world) is a decision that can result in undesired costs in time, money, data, and health (and not in that order), most significantly for the patient, so it is an outcome worth analyzing.

The results – using the Personal Health Record is associated with a choice to stay a member/patient

The actual likelihood is 2.578 times more.

Interestingly, the other factors that are associated include increased age, longer tenure of membership, high illness burden, presence of hypertension.

These results highlight what can be discovered in an integrated system – there is an ability to aggregate clinical and usage data (in a privacy protected way) to provide insights for all of health care.

Even more interestingly, the effect exists across all levels of tenure (from less than 1 year to greater than 10 years) but was greatest for members who were with Kaiser Permanente for less than a year. Check out the figure on page e251 to see this comparison – it’s striking and it implies that a Personal Health Record may have important impacts in the joining of a practice or health system. Some would say (myself included) that this is a critical time to establish communication and build solid relationship with a physician and with good health.

Before you say, “Ted, this data just shows that people who like their health system or are healthy tend to use its personal health record,” the investigators worked to address this:

To control for self-selection bias, we performed a matched case-control analysis with propensity scoring and exact matching; propensity score matching methods control for confounding factors to some degree but do not address causality.

What this means is – it is true that we cannot say that the PHR caused people to stay with their Kaiser Permanente health care. At the same time, we can say that patients in similar situations (age, illness, time in the system) had the same associations with retention. One more thing, the investigators looked at voluntary retention only – involuntary termination, which happens when an employer changes your health plan choices, was not included for obvious reasons.

Not saying, “I told you so.”

Well before Meaningful Use rules came out, I remember having a dialogue with someone about their potential, and was told, “Ted, patient access is just a distraction when it comes to meaningful use regulations.” I knew at the time that patient access was the right thing for the people we serve. Now everyone can know that this is the right thing for the people who serve them, too.

Performing well for patients includes loving what you do to support people in achieving their life goals through optimal health, and loving it when they get there. So it’s not that anyone lost the argument I had back in 2009, it’s that we all won :).

Here’s what a strengthened relationship looks like, as embedded in the press release about the study:


Hi Ted – looking back through several of your posts related to patient portal users and usage, and of course, experience and meaningful use…to prepare for a Consumer Health Informatics course I’m teaching at OHSU. Good paper to disseminate, perhaps with an exercise to for students to add to this comment on their thoughts 🙂

Other examples? I’m all ears.
Crowdsourcing ideas at…


Ted Eytan, MD