Case History #1
After giving up on e-mail, practice is offering it again
After an unsuccessful experience with e-mail questions and answers, Cancer Care Con-sultants, an oncology practice in the Los Angeles area, is trying again.
This time, instead of answering generic questions from people who find the practice’s Web site, the physicians are considering offering patients the opportunity to e-mail the on-call doctor to ask questions that would otherwise be handled by telephone.
"With our practice, patients can call up and get the on-call doctor in a matter of minutes. The e-mail will be more of a convenience for patients who have questions that could wait until their next visit," says Michael Steinberg, MD, a cancer specialist and founding partner of the practice.
For instance, a breast cancer patient who wants to know if she can lift weights wouldn’t want to call the doctors at 10 p.m. but might not want to wait two months for her next follow-up visit. "If the doctor on call doesn’t know the patient he can forward the e-mail to the patient’s physician who can quickly answer the question, print it out, and insert it into the chart so it can be part of the medical record," Steinberg says.
Patients who call the office during the day can talk to the oncology nurse or wait for the physician to call them back later in the day. "We have a procedure to ensure that everybody is called back that day, but they may not get a return call until that night," Steinberg says.
The practice sees the e-mail questions and answers as a way to raise the service level, not necessarily to increase efficiency, Steinberg says.
Before they launch their new Web site and e-mail service later this summer, Cancer Care Consultants is grappling with the medical legal issues, he says. "We don’t want to be dispensing information to patients we haven’t seen, and we want to have the confidentiality issue solved before we go live." (See related story, p. 85.)
The practice is exploring ways to create a secure area for information interchange with patients and is working with an Internet professional to make sure that the communications will be confidential.
When Cancer Care Consultants developed its first Web page with e-mail capacity in the late 1990s, most of the questions were from relatives of patients looking for general information on the disease.
"Many of the questions we were getting contained inadequate information. After attempting to answer them, we ended up referring patients to other Web sites that answered generic questions. We realized that we were not doing a service for anyone. We didn’t want to dispense information without having adequate information on which to base our answer," Steinberg says.
After three years, the practice shut down its original Web page in 1997 and started last fall to develop a new Web page to provide patient education and answer questions for established patients.
"If the questions are easy to answer, we can refer the patients back into the Web site for the patient education information. Or we can tell them to make an appointment to see us in a day or two," he says.
Last November the practice started setting up the components for the new Web site and e-mail service. It uses a totally secure intranet that connects physicians in four offices. "We have an internal network. Without using patient names, we discuss cases, share our call schedules and peer review, and scan images for review by other physicians," he says.
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