Physicians needn’t fear avalanche of patient e-mails

After initial spurt, electronic messaging usually levels off, study finds

The growing use of patient portals-due in part to Meaningful Use 2 requirements-has also increased fears among physicians of being inundated with patient e-mails. But a new study of electronic communications between patients and their doctors shows such fears are probably unfounded.

The study, published in the October issue of Health Affairs, looks at patient portal use between 2001 and 2010 at Beth Israel Deaconess Medical Center, an academic medical center based in Boston, Massachusetts. It found that while the overall number of messages sent to participating physicians tripled-from 11.9 to 32.9 per month-most of that growth was due to more patients using the portal.

The average number of messages sent per hundred patients, however, declined from about 28 per month in 2001 to 18.9 in 2005, where it remained for the rest of the years studied. (The study did not include appointment and prescription refill requests that were sent outside of the messaging function.)

“As health care systems consider enabling electronic communication between patients and physicians, some physicians have expressed concerns that this will lead patients to develop a lower threshold for contacting their physician, potentially overwhelming busy providers with messages,” the authors write. “Instead, our analysis found that the volume of secure messaging per patient remained stable after 2005.”

Although 48% of the doctors participating in the study were primary care physicians, they were the recipients of 85% of the messages patients sent. This imbalance may demonstrate “the usefulness of e-mail for first-contact questions related to new problems,” the authors say. But it may also reflect that “secure messaging may be more comfortable for patients and physicians…when relationships are longitudinal in nature, as they often are in primary care.”

The authors note that secure electronic messaging can play an important role in accountable care organizations and other global payment systems by enabling doctors, when appropriate, to respond to patient questions and concerns more efficiently than by telephone or an office visit. Consequently, “a mechanism for reimbursing physicians and accounting for the workload of electronic messaging will be important.”

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