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Physician-Patient E-Mail Can Save Both Time and Cost

Cheryl Clark, for HealthLeaders Media, May 13, 2009

As a new employee with HealthLeaders Media, I joined the company health plan, and needed to transfer my prescriptions from a mail-order pharmacy in Florida.

It turned into a bureaucratic hassle.

So I e-mailed my internist asking if he would write me a new prescription that I could send to my new plan's pharmacy.

"Of course," he affably replied.

No need to schedule an appointment for an office visit. No need to wait three to six weeks. No need to waste his time or mine for something so routine. My prescription was in my snail mailbox a short time later.

Just as the Obama administration this week is encouraging providers everywhere to be creative in reducing unnecessary costs, it seems as if both my doctor and I were doing our small part too.

Greater exchange of health information between physicians and patients through e-mail is the wave of the future, says Joe Scherger, MD, vice president for primary care at Eisenhower Medical Center, in the Coachella Valley near Palm Desert, CA. It's one of many easy ways to reduce unnecessary health costs for providers, health plans, and patients. In rural areas or places where transportation is a challenge, it can save hours of time for patients and avoid many hours of lost time from work or family responsibilities.

It can also improve patient care by increasing the linkages and communication between patients and their physicians. It makes patients more pro-active about taking responsibility for their health. Given the ability to e-mail their physicians, they are more engaged in the process.

Scherger and many other physicians who use e-mail to advise their patients say that 50% or more of visits to the doctor aren't necessary; they're just traditional. It's not always essential for the patient to return to the office for the results of a test, for example.

The care is necessary, absolutely, they say but providing that at all times in an office setting is not.

According to an article in the March/April Health Affairs, Kaiser Permanente documented a decline of costly office visits to primary care providers by 25% and to specialists by 21% for specialists. The improved efficiencies were seen between 2004 and 2005 in an ambulatory population of 225,000 enrollees after implementation of a comprehensive electronic health record system including secure e-mail messaging and telephone office visits.

But that's a closed system that many providers think is not transferrable to the typical physician practice.

Doctors and payers have to figure out a way to get paid for their time looking through their patients' e-mail throughout the day, double-checking with charts and records and responding appropriately. For the most part, insurance plans and government programs so far won't pay for it although Medicare has launched some demonstration projects.

The system also must devise a way to educate patients on what are appropriate topics for e-mail, and what should have them calling 911 or getting themselves quickly to an urgent care setting. Conveying information about a rash or a blood glucose reading may be entirely appropriate via e-mail, but complaining about chest or sharp abdomen pain is not.

Soon to come to Palm Desert under Scherger's direction is a program called "Eisenhower Personalized Care-$365," a plan by which patients pay $1 a day for "open-ended e-mail communication with their physicians that's apart from necessary office visits," he says. The endpoint is "better management of chronic illnesses resulting in reduced hospitalizations, and reduced costs."

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