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Health Care Manag Sci. 2018 Dec;21(4):475-491. doi: 10.1007/s10729-017-9404-8. Epub 2017 May 18.

The impact of e-visits on patient access to primary care.

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Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, USA.
Center for Quality and Productivity Improvement, University of Wisconsin, Madison, WI, USA.
Dean Health System, Madison, WI, USA.
Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI, USA.


To improve patient access to primary care, many healthcare organizations have introduced electronic visits (e-visits) to provide patient-physician communication through secure messages. However, it remains unclear how e-visit affects physicians' operations on a daily basis and whether it would increase physicians' panel size. In this study, we consider a primary care physician who has a steady patient panel and manages patients' office and e-visits, as well as other indirect care tasks. We use queueing-based performance outcomes to evaluate the performance of care delivery. The results suggest that improved operational efficiency is achieved only when the service time of e-visits is smaller enough to compensate the effectiveness loss due to online communications. A simple approximation formula of the relationship between e-visit service time and e-visit to office visit referral ratio is provided serving as a guideline for evaluating the performance of e-visit implementation. Furthermore, based on the analysis of the impact of e-visits on physician's capacity, we conclude that it is not the more e-visits the better, and the condition for maximal panel size is investigated. Finally, the expected outcomes of implementing e-visits at Dean East Clinic are discussed.


Cycle time; E-visits; Panel size; Patient access; Primary care; Queueing

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