The more effectively patients and physicians can communicate the better healthcare will be. And that includes better electronic communications, such as by e-mail. Yes, I understand doctors’ concerns that it would take up too much of their time—uncompensated time at that—and expose them to liability and leave an electronic trail of typos. But I believe that deep down inside they also know it is the right thing to do.
Almost every non-healthcare business uses e-mail to communicate with its customers (and it’s probably safe to drop the modifier “almost” on that one). And we know that most patients would like the option to e-mail their doctor.
Resistance from physicians is hard to overcome, but one recent study might give them a push in the right direction. In a study of 35,423 people with diabetes, hypertension, or both, the use of secure patient-physician e-mail messaging was associated with a statistically significant improvement in effectiveness of care during a two-month period, according to a Kaiser Permanente study published in the July issue of the journal Health Affairs. Effectiveness was measured by the Healthcare Effectiveness Data and Information Set.
In addition to better care, other findings that might sway physicians include:
- An improvement of 2.0 to 6.5 percentage points in performance of other HEDIS measures such as cholesterol and blood pressure screening and control.
- The ability to replace some outpatient visits, this improving the efficiency of care.
- Physicians participating in the study said they were not overwhelmed by a large number of e-mails. Earlier studies showed that physicians received two to 12 messages each work day and responding to each took an average of 3.5 minutes.
- Message threads were shorter than one might think, too—on average, exchanges contained just slightly more than one patient message and one physician message.
- Most patient-generated emails were not frivolous: 63% required clinical assessments or decisions and 24% required clinical action such as ordering a lab test.
- Offering patients the ability to communicate via e-mail can improve physician-patient relationships (thus improving continuity of care), support patient self-management, and improve patient satisfaction.
Feedback from physicians was generally positive, according to the study’s authors. “Many physicians perceive that the use of e-mail increases their efficiency and improves the care they provide. The top five reasons that patients e-mail their physicians, according to Kaiser, are a change in health condition, to check lab results, to report a new condition, to check on drug doses, and to inquire about a new drug.
In addition, physicians looking to get stimulus money under the American Recovery and Reinvestment Act for meaningful use of electronic medical records must incorporate secure patient-physician messaging into their EHRs.
Kaiser is, of course, a leader in electronic communications. Through its online portal, patients can access lab results, pharmacy records, prescription refill information, self-care instructions, and online educational materials. The organization, frankly, has resources that the average physician does not. E-mail communication is still not reimbursed, and face-to-face visits are still the standard of care for quality measures such as HEDIS. Further, even when free online communication resources are available, they are not used by certain populations, including those who are underserved.
Surely, though, the healthcare industry can figure out a way to solve these problems or simply agree that they are not enough to provide a service that the public clearly wants, that improves quality of care, and in fact saves physicians time and reduces healthcare costs. Physicians don’t get paid to return phone calls, either, for example, but most still call their patients when warranted. It’s time for physicians to overcome their resistance to online messaging. And if they don’t? I say we take away their smart phones and see how they like being disconnected from their own worlds.
Data-loving physicians can read the full study, Improved Quality at Kaiser Permanente Through E-mail Between Physicians and Patients, in the July issue of Health Affairs (subscription required).