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Hessam Bavafa

Designed to Streamline, Health Care E-Visits May Increase Office Appointments

by Hessam Bavafa Monday, August 28, 2017
Female physician seated in front of laptop computer

The omni-channel model of customer service—giving the customer or consumer myriad ways to access a product or resource—is not new. Banks have long offered patrons the option of using online banking, ATMs, or walking into a local branch. Retail has changed as well: I order from Amazon frequently and I have never interacted in person with an Amazon employee. In my courses, students can talk to me after class, contact me via email, or make an appointment during office hours. Most will bypass the latter—they can save valuable time and usually get their questions answered with just a quick email.

In my research with co-authors Lorin Hitt and Christian Terwiesch, both at the University of Pennsylvania, we looked at the omni-channel customer service model applied in a health care setting. Health care systems have introduced e-visits and patient portals as a way to streamline operations and to provide the best care at the lowest cost. E-visits allow patients to contact their doctor directly using a secure, confidential messaging system. Physicians can also recommend follow-up phone conversations and/or office visits beyond the initial email interaction as needed. 

Given the potential of e-visit usage, we questioned whether e-visit adoption could reduce or replace traditional health care service methods. Our study examined data sets from 100,000 patients in a major health care system over a period of more than five years across multiple channels (e-visits, phone, and office visits). The results showed that office visits increased by six percent during this time, and physicians saw 15 percent fewer new patients each month since the e-visit system was implemented. 

What we find is that as the e-visit adopters consume more of the doctor's office visit capacity, it's crowding out the time that would have been available to new patients. In other words, whenever you have something coming in, it's inevitably going to squeeze something else out: either the physician has to work more, or his or her ability to take on new patients is reduced.

Hessam Bavafa

Hessam Bavafa, assistant professor of operations and information management

We also talked to doctors about what they perceived as some of the limitations and considerations of adopting a secure messaging system for patient care, including why it might result in more frequent office visits. These issues are not unique to our study and have been discussed in relation to other settings as well:

  Ambiguity: Email as a medium can be ambiguous. Doctor and patient interactions are often too complex to diagnose via an email exchange. Many health systems are trying out structured visits, where the patient first answers a series of questions about his or her problem instead of an open-ended "I have a headache." 

  Liability: E-visits carry an inferred degree of liability. If a doctor advises a patient during an email exchange and the patient logs off and takes a turn for the worse, there's a timestamp on that digital interaction.

  Payment: In the current setting, e-visits are free of charge for patients, and doctors do not receive payment for their services. Some health systems have started experimenting with this issue by charging per e-visit or creating a yearly subscription fee for email access. 

An interesting sidenote: Our results go against the truisms about the younger demographic being among the first to adopt technology trends. The majority of e-visit adopters fall in the 40-60 age range, with an average age of 55 for adopters and 51 for non-adopters. The data also suggests that patients are more prone to adopt the e-visit system if they have an e-savvy care provider.

In summary, the implications for health care systems based on our study are straightforward: A move to an e-visit platform may mean more office visits, not fewer. Clinics assuming that e-visits will free up physicians to see greater numbers of new patients might want to reconsider. Based on our data, at least, that kind of movement does not seem to be happening.

However, it would be a mistake to interpret these findings as being inherently anti-technology. On the contrary, many health care systems are trying to find ways to use this promising channel as effectively as possible. Knowing more about how secure messaging works and under what conditions it can function optimally—e.g., perhaps encouraging different patient groups to use e-visits more or less—can help hospitals better design their e-visit systems. Finding a solution that leads to improved patient health and reduced health care costs is the ultimate goal. To get there, we need to know what didn’t work out in the trial run.

Read the paper “The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care” published by Management Science.

Hessam Bavafa is an assistant professor in the Department of Operations and Information Management and the Michael E. Lehman Distinguished Chair for Inspired Learning in Business at the Wisconsin School of Business.