Why you should e-mail your patients

Key Points

If you haven't yet begun using e-mail to communicate with patients, there are plenty of reasons to start. First is the increasingly loud patient clamor for e-mail, as indicated in one survey after another. The latest is a Harris Interactive/Wall Street Journal poll in which three out of four respondents said they should be able to schedule medical appointments via e-mail or the Internet, and e-mail their doctors as part of their overall medical care-at no extra charge.

Ironically, that proviso is precisely what has discouraged many time-pressed doctors from giving their patients e-mail access. But as patient demand rises, the "no extra charge" barrier is slowly but surely coming down.

Late last year, Aetna and Cigna HealthCare announced that they would dramatically expand programs that reimburse physicians for "virtual visits." Until recently, only a handful of health plans paid doctors for this service, and the news has sparked speculation that other insurers will soon follow. Not surprisingly, the number of physicians who communicate with patients electronically is also on the rise-going from 19 percent in 2003 to 31 percent in 2007, according to a Manhattan Research survey of more than 1,300 doctors. Among physicians who did not yet use a secure online messaging service, one in four said they intended to start in the next 12 months.

E-mail is a timesaver

There's no single model for communicating with patients electronically. Many physicians rely on conventional e-mail. Others subscribe to companies like RelayHealth, Medem, and ZixMail that offer "secure messaging"-an online communication channel that's encrypted and password protected. Still other doctors have access to secure messaging through their EHRs. While the approaches differ, they offer many of the same benefits.

First, efficiency improves. Depending on the functionality of the system or the ground rules physicians establish, electronic messaging can simplify everyday business issues, such as scheduling appointments and processing medication refills. Then there's the reduction in calls: A recent Kaiser Permanente study found that patients who used the secure messaging service available to all members of the giant HMO made 14 percent fewer phone calls to their doctors.

For Ed Bujold, a family physician with a solo practice in Granite Falls, NC, that's reason enough to try electronic communication. "The biggest complaint we hear from patients is that our phone lines are always busy," says Bujold, who just spent $2,000 to purchase MedFusion's secure messaging software and is in the process of having the system installed. "We've had our lines tested and the phone company told us we have enough call volume to warrant six more lines. I can't hire staff to take care of that call volume, so we'll try this."

Because e-mail is asynchronous, it eliminates back-and-forth phone tag. Equally important, physicians say, it allows them to communicate at convenient moments, so long as they reply within the window of time-usually between 24 and 48 hours-they've established with patients. Because messages capture both the physician's and the patient's remarks and can automatically be entered into an EHR or printed and placed in a patient's chart, electronic communication provides exceptional documentation.

Advocates say electronic messaging enhances the quality of care as well. Patients tend to describe symptoms and problems more thoughtfully and thoroughly in an e-mail than they do verbally, and are more likely to discuss sensitive issues online than in face-to-face encounters. Compliance often improves, too, because patients can ask questions they think of later and doctors have a convenient way to follow up.

Matt Handley, an FP with Group Health Cooperative in Seattle, spends between a half hour and an hour each day answering e-mails. But in that time, Handley estimates, he's "in touch" with nearly as many patients as he sees in his office in the course of a day. Handling routine questions electronically enables him to provide same-day access for patients who need to come into the office, he finds. And patients love it.

"There's nothing that bonds your patients to you more tightly and deepens the physician-patient relationship more than meeting their needs in a way that is most important to them," says Handley. "Electronic communication is a practice differentiator. This is a service that most doctors still don't offer, and if you do, I think you are more likely to have your patients stay with you."