The e-mail barrier

If you ask consumers whether they’d like to be able to communicate with their doctor by e-mail, the majority would probably say yes. But if you added up the number of doctors who actually offer this option to their patients, it would be very few.

Despite the pervasive presence of e-mail in how we live, work, shop and keep in touch with family and friends, the medical community has been remarkably slow to adopt this form of technology to communicate with patients.

A new national study by the Center for Studying Health System Change attempts to put some numbers on this issue – and to explain the barriers that may be preventing physicians from using e-mail more fully.

Some of the findings were frankly rather startling. For instance, a 2008 survey of more than 4,200 physicians in the U.S. found that barely one-third of these physician practices even had the information technology to e-mail their patients – and among those who did, fewer than one in five actually used e-mail routinely to communicate with their patients.

Granted, these data are two years old. A more current survey might show the numbers have shifted upwards.

Nevertheless, compared to the rest of the world, there has clearly been a significant lag in the adoption of e-mail in medical practice. The health tracking physician survey conducted by the Center for Studying Health System Change found the use of information technology was highest for viewing lab, radiology and other diagnostic test results. Nearly half of the doctors who responded to the survey also used information technology to access parts of the patient record, such as notes or medication lists. About one-third used IT for writing prescriptions.

E-mail came in dead last in the survey, both in its availability and its use.

Some factors seem to predict how likely a physician will be to use e-mail. Practices that are still entirely paper-based, for instance, have the lowest rate of e-mail use. Smaller practices and rural practices also are less likely to use e-mail, as are physicians who are older. How the physician was paid seemed to make a difference as well; physicians who received a fixed salary used e-mail with their patients more often, perhaps because they faced fewer productivity pressures.

Although it’s easy to criticize physicians for being behind the times, the public shouldn’t underestimate how formidable the barriers can be. The HSC report lists the many challenges:

Physician concerns about increased workload without reimbursement, uncertainty about impacts on quality of care, and challenges related to data privacy and security and medical liability have hindered adoption and use of e-mail to communicate with patients.

The survey notes that doctors aren’t necessarily averse to the overall use of e-mail. The survey participants were much more likely to communicate via e-mail when the communication was with another clinician. Also, the survey didn’t look at the extent to which e-mail communication might be delegated to other practice staff. If e-mail with patients is being handled by nurses or other staff, the study might have underestimated how broadly e-mail is used by the practice as a whole, the study’s authors wrote.

It’s clearly going to take some policy change at the federal level to make e-mail a more attractive communication option between doctors and patients. Doctors aren’t going to use it if they’re worried about their liability, and they certainly aren’t going to use it if their clinic doesn’t even have up-to-date information technology. The release this past July of the final rules for Medicare and Medicaid incentive payments linked to “meaningful use” of the electronic medical record may help speed the adoption of paperless systems and foster an increase in e-mail communication. The HSC study’s authors also note that “formal protocols governing message triaging, turnaround time, appropriate use and documentation can help to address physicians’ liability concerns.”

The impact on the doctor’s time is a separate question. Although other studies suggest that allowing patients to e-mail their doctor doesn’t generally result in opening the floodgates (there’s even some evidence it can cut down on telephone calls), physicians are reluctant to add yet another task to their already busy day – especially if they aren’t going to get paid for it. Health plans need to recognize that 21st-century communication isn’t what it used to be, and that innovation and open-mindedness are called for here. Consumers might have to be more open-minded too in their willingness to perhaps pay a little extra to be able to e-mail their doctor.

The big question, of course, is whether e-mail between doctors and patients truly does improve patient care. If it doesn’t, or if the benefit is only marginal, then all of the effort to develop this will have been for naught. Deep down, however, I can’t imagine that e-mail won’t help facilitate and improve the dialogue. Good communication lies at the core of effective, quality health care. Giving doctors and patients another tool for talking to each other can’t help but enhance their ability to provide and receive good care.

Photo: Wikimedia Commons

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