Use of e-mail grows as a patient satisfier
Reductions cited in administrative hassles
When it comes to improving communicating with patients, "the telephone is no longer adequate," says Daniel Hoch, MD, assistant in neurology and director of neurology operations improvement at Massachusetts General Hospital in Boston.
"There are too many calls, and people are dissatisfied with a quick answer. The Web-based approach is more convenient, and more information can be given," says Hoch, who heads a pilot e-mail program at the hospital.
The neurology department has a service that allows patients to post a message to Hoch on a bulletin board. He answers directly to the bulletin board, and the postings are saved to provide a record of the interaction that is easy to review. The site is password-protected, and more secure than standard e- mail, he says.
He uses e-mail for such purposes as answering patient questions, leaving instructions for medication changes, and directing patients to Internet sites that might supply more information. Hoch hopes that adding e-mail will cut the time he has to spend on the phone by 25%-50%.
"We’ve found e-mail is generally more efficient than telephone calls since it can eliminate constant rounds of phone tag. Then there is the ability to take care of business from remote sites, to work at odd hours without worrying about waking someone up," he says.
Another benefit is since e-mail messages can be printed out, there is a written record for both the patient and the physician.
Small, but growing
Hoch is on the cutting edge of using a technological tool that could transform the day-to-day practice of medicine. Only about 5%-10% of physicians currently correspond with their patients by e-mail. This is up from less than 2% just a few years ago.
"The small group of clinicians who routinely use provider-patient e-mail say that it has revolutionized their practice in very positive ways," notes Tom Ferguson, MD, an Austin,TX-based consultant.
"In many cases, they can avoid the need for a clinic visit by an on-line exchange. And there is always a full record of the on-line conversation, so it can automatically become a part of the patient’s medical record."
Ferguson says 25%-30% of doctor-patient e-mails deal with follow-up questions after an office visit. "It’s wonderful when a doctor can say, Send me an e-mail in 10 days to let me know how you’re doing.’"
Internist Paul M. Ford, MD, an assistant professor of medicine at Stanford University in Palo Alto, CA, has been using e-mail with his patients for about five years.
"E-mail gets you take care of a lot of the administrative stuff you have to do in medicine," he says. "I really believe if we had more patients using e-mail, it would decrease our overall practice costs. We wouldn’t need so many people to answer the telephone [and] in the file room moving charts around. Also, patients would feel more connected to the practice, which could help financially in the long run."
Ford’s practice of 10 physicians has a central e-mail address and a software filtering program that helps automatically route messages to the appropriate people. An automatic reply is sent to tell patients their message was received and who will take care of their request.
Sometimes, the practice adds standardized reminders to the automatic message such as information about flu shots. Many of the messages involve prescription refills, appointments, and specialist referrals that can be handled by someone other than a doctor.
Physicians only give out their private e-mail addresses when they feel it’s appropriate. The American Medical Informatics Association Internet Working Group has developed "Guidelines for the Clinical Use of E-mail with Patients." The guidelines are available at www.amia.org.
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