E-mail "visits" can save you time

There's no justification for doctors' typical reason not to e-mail with patients, this expert says.

Some physicians have started using e-mail to communicate with their patients, but most of them are doing it as an add-on to their busy visit schedules. To take advantage of e-mail's efficiency, it should be integrated into the schedule, replacing the many unnecessary visits that all offices log. By using e-mail this way, physicians can save time and take better care of more patients. Here's how:

Currently, most health care communications occur in face-to-face visits or over the telephone. Offices have multiple phone lines flashing at the same time, with patients being put on hold just to enter the system or get a simple question answered. Physicians are frantically trying to see patients and respond to phone messages at the same time.

Yet a great deal of clinical communication does not require doctor and patient to be present at the same time. To answer a question about how to take a medication, for instance, the physician doesn't have to be in the same room or on the phone with the patient. E-mail provides an asynchronous form of communication in which physician and patient can correspond when it's mutually convenient. Patients don't have to wait on hold, and doctors and staffers don't have to play phone tag with patients.

Online communication has its limits, to be sure. Messages can be misunderstood or used inappropriately. But telephone communication has drawbacks, too, and it's become the principal means by which most after-hours care is provided.

Many physicians are also concerned that e-mail with patients might violate HIPAA regulations. But secure online messaging systems that comply with HIPAA privacy rules are now available from several vendors. These systems can be used only to protect your e-mail or they can be imbedded in an interactive practice Web site.

And from a liability viewpoint, online communication is better than telephone calls because it's self-documenting. E-mails can be printed out easily and inserted in the patient record, or copied to electronic medical records. Patients must understand, however, that they should never use e-mail in an emergency.

How to modify your office schedule

Online communication has the potential to transform the nature of today's office environment, making it much less stressful and harried for both doctors and patients.

Rather than seeing 24 to 30 patients a day, and dealing with nearly as many phone calls, a physician could care for the same number of patients online in 60 to 90 minutes. The rest of the day might be spent seeing 8 to 12 patients who have complex needs in unhurried visits that last 30 to 60 minutes each. If a patient problem required two hours of face time, that could be accommodated without stealing time from the care of other patients.

Used to seeing all your patients, you may fear a loss of intimacy if you e-mail most of them. In my experience, however, more-frequent electronic communication enhances the patient-physician relationship, and visits are more rewarding when less rushed.

A major advantage of a schedule that integrates e-mail into the workday is that office visits are reserved for those who really need them. Longer appointments for these folks are much more professional than brief, hurried visits, in which patients with complex problems are rarely given the services they need.

Below you'll find examples of an old and a new office schedule. Even though fewer patients are seen under the new schedule, more receive care. The front and back office staffs are also able to deal with more patients each day in a less hectic manner, thanks to the asynchronous communication offered by e-mail.

How to address financial issues

Although some insurance companies have begun paying for e-mail on a limited basis, it's unlikely that this will become widespread or that it could totally replace the income lost by having fewer visits. A monthly user fee could help make it possible for practices to offer e-mail service on top of office visits.

Capitation and other prepaid reimbursement systems offer more flexibility in matching finances to the way care is delivered. Under capitation, doctors don't depend on visits for revenue, and the most efficient methods of care are desirable. Heavily capitated practices have an incentive to provide more care over the phone. The same is true for e-mail, and physicians in these practices should try using e-mail more often with their capitated patients.

Since visits are an expensive way to deliver medical services, this new model of office practice should be far more efficient than the current one. When I began giving e-mail access to all my patients seven years ago, my cost per patient went down considerably. There were not only fewer visits, but also fewer tests. It turns out that it's easier to reassure patients that they don't need a test or a prescription by e-mail than it is when sitting face to face with them.

While current reimbursement methods are not propitious for practices that do a lot of e-mail consultations, this new model promises to provide better care at lower cost. It offers even more to patients and doctors when combined with electronic medical records and the latest clinical decision support tools. Together, these new knowledge management and communication methods can vastly improve how we deliver care.

 

Joseph Scherger. E-mail "visits" can save you time. Medical Economics Sep. 17, 2004;81:37.