Contrary to expectations, electronic medical visits (e-visits) trigger additional clinic visits, rather than serving as an office visit substitute, affecting a physician’s ability to take on new patients. Study results were published in Management Science.

Electronic communication is used increasingly in primary care. A 2012 survey found that 57% of healthcare providers had a patient portal in place, with many others planning to implement one. However, there is limited research on whether e-visits are successful in reducing the use of office and telephone visits, or in improving the quality of care.

Christian Terwiesch, PhD, from the Wharton School and the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues used a large healthcare system data set to research the issue of whether e-visits improve healthcare efficiency by preempting office and telephone visits, and improve overall patient health.

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The data set contained records from nearly 100,000 patients and covered the years 2008 to 2013. Study investigators used difference-in-difference estimates and conducted matching analyses and instrumental variable analysis to account for potential variation in the timing of patient e-visit adoption.

Dr Terwiesch and colleagues found that e-visit adoption was associated with an increase in office visits of about 6%, with mixed results on telephone visits and patient health. They note that the effect of these additional visits comes primarily at the expense of taking on new patients, with some negative effects on non-e-visit-adopting patients. The authors also found that e-visit adoption increases care consumption, not only in terms of increased office visits but also in terms of increased use of other healthcare resources such as additional testing.

The authors called for additional analyses to provide a more nuanced investigation of the effect of e-visits on patient healthcare outcomes, and to provide evaluation of the longer-term effects of such technologies on healthcare delivery.

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“Until these additional analyses can emerge in the literature, we hope that our study will help inform managerial decisions on whether and how to promote e-visits within primary care systems,” they concluded.


Bavafa H, Hitt LM, Terwiesch C. The impact of e-visits on visit frequencies and patient health: evidence from primary care [published online February 5, 2018]. Manage Sci. doi: 10.1287/mnsc.2017.2900