As we move progressively towards a more 'connected' healthcare delivery setting, we are increasingly faced with greater demand from patients to communicate via e-mail. This is a natural extension of the rest of the world. I can communicate with my bank, I can communicate with the airlines or just about any other consumer service that I need, how come I cannot communicate with my physician? In a fee for service setting, a reduction in patient visits (as a result of e-mail) could translate into increased workload and reduced income if a physician sees fewer patients and is unable to receive compensation for e-mail.
This was made evident by a study out of Kaiser Permanente in the US. In Canada, physicians have generally resisted using e-mail for a number of reasons, compensation being one, but the major reason being the security issues associated with non-secure e-mail.
"A Kaiser Permanente study showing that physicians who e-mailed with patients saw a drop in visits raises the specter that online communication might reduce revenue. But doctors who were early adopters in e-mailing patients -- and who didn't participate in the study -- say that even though such communication might keep some patients out of the office, it opens up more space for patients who might have a more pressing need to come in. And they say patient e-mail reduces the amount of time they spend on the telephone with patients -- which Kaiser's study also found to be true.
Jasmine Moghissi, MD, a family physician in solo practice in Fairfax, Va., has been e-mailing patients for several years. She said that although it hasn't reduced the amount of work in the office, it's made the same amount of work easier to handle. "It's like taking a phone call at your leisure. I almost never talk to patients on the phone. I find when I do, it's like an office visit, it's like 20 minutes," she said. "I will do the e-mail with them because I can control how much time I spend on it, and I can control when." Researchers studied 4,686 patients from the Kaiser Permanente Northwest region who use the medical group's KP HealthConnect system, which gives secure e-mail access to doctors. Members had used HealthConnect for at least 13 months and had used at least one feature. The group was compared with a control group of 3,201 members, matched by age, sex and conditions, who did not use HealthConnect. Annual office visits for registered HealthConnect users decreased by 10.3% during the study, conducted between September 2002 and August 2005. The corresponding decrease in office visits for the control group was 3.7%. HealthConnect users also phoned their physicians 13.7% less than did the control group.
Have you had experience using e-mail with your patients? If in a fee-for-service practice, have you noticed a reduction in patient visits? Has e-mail increased workload without obvious benefits? E-mail and the demand to communicate electronically is an issue that is going to increase over time. We are going to need to be creative in our approach towards dealing with e-mail communications.
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