The purpose of this study is to assess usage of the virtual health record (VHR), and determine the effects of this technology on healthcare utilization.

National efforts are underway to support the implementation of technology that enables providers to electronically access and view community-wide clinical information for their patients, which has the potential to improve quality of care and reduce health care costs by providing timely and complete health information at the point of care. However, few empirical studies have been conducted to evaluate the economic effects of this technology. Along with other stakeholders, New York State is funding regional health information organizations (RHIOs) to deploy a virtual health record (VHR), which is technology that enables providers to electronically access community-wide clinical data for patients who have consented to have their clinical data accessed via a web portal. RHIOs bring together multiple stakeholders, including physician practices, hospitals, pharmacies, and laboratories, for the purpose of exchanging clinical information electronically across communities. The investigators will conduct a multi-RHIO retrospective pre-post, cohort study of adult patients who have consented to have their clinical data viewed by their providers using the VHR portal. Examining the effects of electronically accessing clinical data on healthcare utilization across multiple settings and communities can help inform the national health IT initiative that is underway and allow assessment of the economic value of these technologies.

Inclusion Criteria:

• Patients that are aged 18 and older who have consented during the year 2009 to allow their provider use of their VHR data and had at least one visit to a healthcare provider that is a VHR user within 6 months after they consented to allow their provider use of their VHR data. (Note: we only wish to include individuals who have had the opportunity for their data to be viewed using the VHR web portal). Providers who are participating in the Regional Health Information Exchange (RHIO).

Exclusion Criteria:

• Patients and providers who do not meet the above criteria

Adult patients with concurrent controls who have consented to have their clinical data viewed by their providers using the VHR portal provided by RHIOs. Providers who are participating in the Regional Health Information Exchange (RHIO).