The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care

Abstract

Secure messaging, or "e-visits," between patients and providers has increased sharply in recent years, and many hope they will help improve healthcare quality while increasing provider capacity. Using a panel dataset from a large healthcare system in the United States, we find that e-visits trigger about 6% additional office visits, with mixed results on phone visits and patient health. These additional visits come at the sacrifice of new patients: physicians accept 15% fewer new patients each month following e-visit adoption. Our dataset on nearly 100,000 patients spans from 2008 to 2013, which includes the rollout and diffusion of e-visits in the health system we study. Identification comes from difference-in-differences estimates leveraging variation in the timing of e-visit adoption by both patients and providers. We conduct several robustness checks, including matching analyses and an instrumental variable analysis to account for possible time-varying characteristics among patient e-visit adopters.

Keywords: health care operations, health information technology, secure messaging, e-visits, patient portals