Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study

Journal of General Internal Medicine (2021)Cite this article

Abstract

Background

In an effort to foster patient engagement, some healthcare systems provide their patients with open notes, enabling them to access their clinical notes online. In January 2013, the Veterans Health Administration (VA) implemented online access to clinical notes (“VA Notes”) through the Blue Button feature of its patient portal.

Objective

To measure the association of online patient access to clinical notes with changes in healthcare utilization and clinician documentation behaviors.

Design

A retrospective cohort study.

Patients

Patients accessing My HealtheVet (MHV), the VA’s online patient portal, between July 2011 and January 2015.

Main Measures

Use of healthcare services (primary care clinic visits and online electronic secure messaging), and characteristics of physician clinical documentation (readability of notes).

Key Results

Among 882,575 unique portal users, those who accessed clinical notes (16.2%; N = 122,972) were younger, more racially homogenous (white), and less likely to be financially vulnerable. Compared with non-users, Notes users more frequently used the secure messaging feature on the portal (mean of 2.6 messages (SD 7.0) v. 0.87 messages (SD 3.3) in January–July 2013), but their higher use of secure messaging began prior to VA Notes implementation, and thus was not temporally related to the implementation. When comparing clinic visit rates pre- and post-implementation, Notes users had a small but significant increase in rate of 0.36 primary care clinic visits (2012 v. 2013) compared to portal users who did not view their Notes (p = 0.01). At baseline, the mean reading ease of primary care clinical notes was 53.8 (SD 10.1) and did not improve after implementation of VA Notes.

Conclusions

VA Notes users were different than patients with portal access who did not view their notes online, and they had higher rates of healthcare service use prior to and after VA Notes implementation. Opportunities exist to improve clinical note access and readability.

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Funding

This study was funded by the Department of Veteran Affairs (grant VA241-12-D-0224).

Author information

Affiliations

  1. Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, USA

    Amanda C. Blok

  2. Systems, Populations and Leadership Department, School of Nursing, University of Michigan, Ann Arbor, MI, USA

    Amanda C. Blok

  3. Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Daniel J. Amante, Rajani S. Sadasivam & Stephanie L. Shimada

  4. Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Medical Center, United States Department of Veterans Affairs, Bedford, MA, USA

    Timothy P. Hogan & Stephanie L. Shimada

  5. Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA

    Timothy P. Hogan

  6. Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA

    Stephanie L. Shimada

  7. Maine Behavioral Healthcare, South Portland, ME, USA

    Susan Woods

  8. KMN Consulting Services, Coxsackie, NY, USA

    Kim M. Nazi

  9. Learning Health Systems, Department of Medicine, Wake Forest University, Winston-Salem, NC, USA

    Thomas K. Houston

Authors
  1. Amanda C. Blok
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  2. Daniel J. Amante
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  3. Timothy P. Hogan
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  4. Rajani S. Sadasivam
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  5. Stephanie L. Shimada
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  6. Susan Woods
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  7. Kim M. Nazi
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  8. Thomas K. Houston
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Corresponding author

Correspondence to Amanda C. Blok.

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This study was reviewed and approved by the Edith Nourse Rogers Memorial Veterans Hospital and the University of Massachusetts Medical School Institutional Review Boards.

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Blok, A.C., Amante, D.J., Hogan, T.P. et al. Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06304-0

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