To e’ or not to e’: Practices move cautiously toward the electronic age
Patients are demanding access to health care through the Internet
Your patients can book an airline flight, order a week’s worth of groceries, or sell 100 shares of stock on the Internet — often in less time than they spend on hold when they call your office for an appointment.
They can use the World Wide Web to check out every vacation home for rent in the panhandle of Florida, gather enough information to write a research paper on almost any subject, or fill out and file their income tax return in the time it may take to get a reply to a simple question from your office. Survey after survey shows that patients would welcome an opportunity to correspond with their doctors and make appointments over the Internet.
"My doctor friends tell me that medicine is different, but my expectations are being raised by other industries. We continue to make health care pretty inconvenient for people. It’s no wonder patients are getting angry and more demanding," says Tom Aug, a partner with Develop-ment Partners, a Cincinnati firm specializing in patient satisfaction improvement for physician group practices.
Internet technology is making tremendous changes in the way health care is delivered, and the trend can be expected to continue.
"As patients are increasing their use of the Internet, they are developing the expectation that physicians make electronic communication available," says Gwen Hughes, RHIA, practice manager with the American Health Information Management Association in Chicago. Communication by e-mail has its advantages, she points out. "When used in addition to, rather than a substitute for, face-to-face communication, e-mail may enhance the patient/provider relationship.
Here are some other advantages to using e-mail to communicate with your patients:
• It eliminates playing phone tag or leaving voice mail messages.
• Caregivers have the ability to attach educational material or test results to the communication.
• Staff can print out the e-mail and put it in the patient’s file to document a patient record, rather than relying on your recollection of the conversation.
"It’s clear that technology is here to stay and will play a major role in health care. To deny that it is happening is to put one’s head in the sand," says Bob Waters, a health and telemedicine attorney at Arent Fox Kinter Plotkin & Kahn, a Washington, DC, law firm.
While most physician practices are taking a wait-and-see attitude toward Internet correspondence with patients, a few have been pioneering the practice with admittedly mixed results. Gregory Pecchia, DO, with Family Practice Physicians Inc. of Orange, CA, has been corresponding via e-mail with his patients for five years. "With e-mail, patients are able to communicate their needs and questions within their own time and are not limited by the time constraints of an office visit or telephone call," he says.
Pecchia gets about 15 to 20 e-mails a day from patients who use the system to make requests for appointments, prescription refills, and general information. Corresponding by e-mail gives patients an opportunity to clearly state their needs, rather than relying on a staff member to transcribe their questions or concerns into a handwritten note, he adds.
However, Pecchia didn’t initiate the process without drawbacks. When the practice was using paper records, the e-mail correspondence entailed extra work in printing out the correspondence and attaching it to the paper record. An integrated practice management situation solved the problem, he says.
The Perinatal Center in Des Moines, IA, gets about 10 to 15 e-mailed questions a month, mostly from people in rural Iowa who are seeking information on genetic counseling or diseases, says Brad Hart, practice manager. "Patients are becoming more astute in researching their own medical care. If their doctor tells them they have a certain problem, they look it up on the Internet and follow the trail to us," Hart says.
Physicians at the center took a visionary approach to electronic health care when they set up a Web page two years ago and added the e-mail function last year, he says. "They realize that e-health is where we are going. We’re not waiting for everyone to get on the train. We’re getting on it first." However, the practice has not had a lot of success in using the e-mail system for its own patients. "They expect the immediacy of a phone call," Hart says.
Mid-Iowa Fertility, an infertility diagnosis and treatment practice, regularly fields questions over the Internet, including information about treatment options, costs, outcomes, and expectations, says Hart, who also manages that practice.
Waters sees the Internet as a powerful tool that allows practices to provide more information to consumers and patients. But there also are risks, he points out. For instance, unless you have a sophisticated e-mail security system, you can’t assume your correspondence is private. (For more on security and other risks, see list, p. 84, and related article, p. 91.)
But, because of patient demand, physicians such as Michael Steinberg, MD, a cancer research specialist and founding partner of Cancer Care Consultants, a Los Angeles area oncology practice, are developing e-mail capabilities.
Steinberg says many of his patients ask for his e-mail address on their first visit. "This technology is so new we’re not sure what the risks are. But at the same time, we are developing a plan for using e-mail and the Internet to address patients’ concerns in an efficient, safe, and confidential manner," he says. (For stories on good and bad experiences with e-mail, see case histories, below and pp. 83-85.)
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