Physician-Patient E-mail Improves Quality, Study Finds

Some doctors have been reluctant to communicate with patients via e–mail, in part because of reimbursement and medical liability concerns. But a new study in Health Affairs provides a compelling case for opening up the inbox to patients: It may improve the quality of care.

Researchers at Kaiser Permanente followed 35,423 patients with diabetes, hypertension, or both, over a two–month period. Those that used e–mail to communicate with their doctors saw a statistically significant improvement in measures from the Healthcare Effectiveness Data and Information Set, a group of performance measures used by the managed care industry.

E–mailing physicians helped improve “control measures” for chronic conditions in particular, says Yvonne Zhou, PhD, director of analytics, evaluation, and knowledge management with Kaiser Permanente. Glycemic control, cholesterol levels, and blood pressure screening measures were 2–6.5 percentage points higher for patients who had e–mail access to a physician.

“Many chronic condition patients really need to have ongoing communication with physicians, especially for control measures like glycemic control and LDL control,” she says. Frequent communication makes it easier to closely monitor and adjust medication levels and quickly react to changes in health, she explains. “These are the big improvement areas for using e–mail.”

The study was a follow–up to previous research Zhou conducted, which found that e–mail communication could reduce the need for office visits by up to 10% and reduce the telephone calls to a practice by 14%.

Despite the administrative and quality benefits of e–mail communication with patients, not all physicians are ready to adopt it in today’s fee–for–service environment. Some argue that e–mail consultations should be reimbursed because they are like a virtual office visit. Others are concerned that delays in responses or information provided in e–mails could increase liability risks.

But potential payment reforms could change the incentives for e–mail use, says Zhou. If Medicare can transition to a performance–based payment system, instead of one based on procedures, then physicians will be able to focus more on patient outcomes instead of individual procedures and visits. “From that perspective, it will probably encourage more doctors to use e–mail, because ... [e–mailing] improves the performance of quality measures,” Zhou adds.

Kaiser had a capitation arrangement with the physicians who participated in the study, so they weren’t operating under the same financial incentives as many doctors.

Even without an overhaul of the reimbursement system, physician–patient e–mail will likely become more common and necessary. Nearly 40% of physicians communicated with patients online in 2009, according to a survey, up from just 25% in 2006. Zhou and her colleagues noted that secure physician–patient e–mail was one of the objectives of the HITECH Act, which provides incentives for electronic health record adoption. And e–mail may be a key tool for reducing readmissions, which has been a goal of recent reform efforts.

“Follow–up e–mails after patients get discharged are really important,” Zhou says. “They can help patients cope with some of the conditions when they get home, which may also reduce readmission rates.”