The E-doc Era

May 1, 2008

Things have really changed.

Things have really changed. A few years ago, I would’ve found it unthinkable that I’ be regularly writing a column. But recently, an editor of this publication read my writings on the Internet, contacted me via e-mail, and now I submit my copy, get edited, resubmit it, and see it published -- all via e-mail. And likely, you’re reading this through an e-mail as well.

E-mail is incredibly handy. So why do so few physicians use it to communicate with their patients? One word: money. Why substitute reimbursed care for nonreimbursed care? And three more words: quality of care. Why give patients another avenue to avoid coming in for a visit? Because of these two factors, two-way e-mail communication has simply remained on the fringes of the physician-patient relationship.

But now things are indeed changing, albeit slowly. Our practice has recently started participating in one-way communication with our patients. This has saved us both time and money. We send lab results, referral details, and recall letters via e-mail. The process is quicker than paper, the information is automatically updated in our electronic medical record, and it saves us lots of postage. Plus, our patients love it.

Many physicians are loath to bring e-mail into daily operations. Let’s debunk some common “e-mail myths:”

  • It is unsafe. Security is a huge concern for people, especially in the area of medical information. Luckily, secure e-mail is readily available through many sources (including Google and Yahoo).

  • It is difficult. You’re reading this article, aren’t you? Really, you are not much different from most people in this manner.

  • Patients won’t want it. We have found the opposite to be true. Even our elderly patients mostly have e-mail accounts (to get pictures of grandchildren) and they are happy to get medical information this way.

  • Patients will abuse it. Certainly, it’s possible for patients to e-mail you with every symptom and worry. However, your system can be set up to handle this possibility. For example, after a certain number of queries, the patient can be prompted to schedule an appointment to discuss her concerns in person. But the vast majority of patients are very judicious in how often they “bother” their doctor. (I even have friends who give patients their cell-phone numbers and they swear they never get called.)

Here are some tips for getting started with e-mail:

  • Start with one-way communication. Introduce e-mail by communicating simple information to patients, such as normal lab results. Don’t let them use e-mail to respond back to you (if possible). If you open up the latter possibility prematurely, you may miss important information. Before you allow your patients to e-mail you, you must have a system in place to deal with these e-mails.

  • See if you already have the tools. We are using a proprietary software solution for secure medical e-mail that is integrated into our EMR. If you have an EMR, it is very likely that this function is already or will soon become available.

  • Make sure the e-mail is secure. Despite your patients’ desire to e-mail you, don’t jump to it without security. Note that the subject of an e-mail may be read by unwanted parties, or the entire e-mail could be read by someone who does not have authority to do so. You are liable for these breaches, so make sure you take the proper precautions to secure patient information. Use the secure e-mail programs available. If you don’t know how to do this, consult a computer professional.

Even if you’re not yet ready to make the jump, you should still prepare for it. Most of your patients are also somebody’s employees. It can be difficult to miss work; e-mailing doctors is one way to deal with this. Also, new reimbursement models will soon come into play, and most of these will embrace the efficiencies afforded by new technologies. In fact, two-way communications (or e-visits) have recently started to be reimbursed by two very large insurance companies on a national level, which solves the money issue but not the quality of care one. Still, expect e-visits to trickle down into a fundamental change in the way we doctors interact with our patients.

Besides, do you really like all of those phone calls?

Robert Lamberts, MD, is a primary care physician with Evans Medical Group, in Evans, Georgia. He is board certified in internal medicine and pediatrics and specializes in the care of adults, pediatrics, diabetes, high blood pressure, asthma, preventative medicine, attention deficit disorder and emotional/behavior disorders. Dr. Lamberts serves on multiple committees at several national organizations for the promotion of computerized health records, for which he is a recognized national speaker. He can be reached at rob.lamberts@gmail.com.