Does Providing Email to Patients Benefit Patient-Physician Communication?

I'm a strong advocate of patient-physician communication by email.

In the Archives of Surgery, a paper was recently published examining the effect of surgeons providing email addresses to patients prior to thyroid or parathyroid surgery. Half the patients received a sheet providing the email address and a statement saying that email was the surgeons' preferred means of communication. The other half received an information sheet without an email address or remark about a preferred means of communication. (The email addresses, however, were also available to both groups on the appointment card and website.)

Here are the results:

Overall, 26 of 100 patients (26%) initiated additional perioperative communication with the surgeon, 19 of 50 (38%) in group E [recipients of email addresses] and 7 of 50 (14%) in group S [no email addresses provided](P < .001). Of those who initiated communication, 22 of 26 (84%) did so by e-mail; 3 (12%), by fax; and 1 (4%), by telephone. For patients using e-mail, 18 of 22 (81%) were in group E and 4 of 22 (18%), in group S (P < .02). Overall, 34 e-mails were sent by 22 patients in the study group. Most e-mails sent focused on only 1 issue; however, some patients raised multiple issues, with the most being 4 issues in a single e-mail. There were no differences in any of the outcome measures in relation to patient satisfaction with communication.

The study authors remark that "Despite concerns about potential medicolegal issues and other disadvantages, providing patients undergoing elective surgery with e-mail access to their surgeon results in improved levels of communication without any demonstrated impairment of satisfaction with outcomes."

What can we learn from this study? When provided with an email address, more than twice as many patients contacted their doctors. On the face of it, this seems like a good thing -- more communication, more questions answered, better informed patients, better patient-physician relationship.

However, the study failed to show a significant difference in patient satisfaction between the two groups. Those who are skeptical about the value of email between physicians and patients might argue that this proves that email provides no demonstrable benefit. With all this additional communication by email -- none of which is reimbursed -- where's the increase in patient satisfaction? The skeptics might reasonably ask: why bother?

In balance, I think this study provides ammunition to both sides of the patient-physician email debate.

(Also posted on The Efficient MD.)

Photo Credit: Eduardo O.

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Someone Please Create Free, HIPAA-Compliant Patient-Physician Email

This is a rant. Or a plea. Or a pitch for a product idea that I wish someone would just run with. It would be invaluable to everyone involved.

Free, encrypted, HIPAA-complaint patient-physician email. Simple. Easy-to-use. Ad-supported. Perhaps by Google ads, like Gmail.

But I'm getting ahead of myself. Think about it. Most physicians actually want to email their doctors. And many doctors would email their patients if there was a free, encrypted, private, easy-to-use system available. But most physician-patient email systems are expensive or are cumbersome to use. (For more background, see this three part series on patient-physician email on Tech Medicine.)

So here's my proposal:

Dear Google (or another company with resources and ambition),

Please create an email system where all communication between physicians and patients is encrypted to comply with the HIPAA privacy law.

Make it free. Advertise it to doctors. Emphasize the HIPAA-compliant part. Emphasize the free part.

Monetize it with Google adwords or some other system. In fact -- if this is Google I'm speaking to -- just build it on Gmail. Countless Gmail users are already fine with seeing contextualized ads right next to their email. I don't think doctors and patients would mind. And if they do, well, those people won't use it. Plenty of other people will.

I understand there are technical limitations. But people have designed HIPAA-compliant patient-physician email systems before. I'm just asking you to do it better. And for free.

It would be huge. Not only in terms of potential advertising revenue, but it would provide a real service to patients who would love to email their doctors. And it might strengthen the physician-patient relationship like few things could.

Thanks for listening.

Photo Credit: Flickr

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Thoughts on Patient-Physician Email (Part 2)

In part 1, I talked about barriers to patient-physician email. In this section, I'll discuss the many potential benefits of email communication between physicians and patients.

The time for the typical office visit has shrunk. Due to many factors including declining reimbursement and the need to see more patients per day, most office visits are now scheduled for 15 minutes or less. Neither physicians or patients are happy about this. Fifteen minutes is hardly enough time for adequate patient education or for forming a bond with your physician.

Enter email, a service which allows more time for physician patient-communication and helps people feel closer to their doctor. A few potential uses for email include:

• Asking about lab results
• Reporting potential side effects of medications
• Clarifying whether it's safe to take a certain medication
• Reporting home blood pressure readings
• Reporting blood sugar readings
• Giving positive feedback
• Giving negative feedback
• Asking for prescription renewals
• Reporting new minor (but important) symptoms
• Communication new medical issues when out of the country
• And many others

Of course, any of these communications could also be made with a phone call -- but with a lot more hassle for everyone involved.

Take this example. Let's say a patient on a cholesterol lowering medication (Lipitor) has a twinge of pain in his left arm. He's heard that Lipitor can cause muscle problems, and is concerned that the twinge might be caused by the medication. One option is to schedule an office visit, but he's reluctant to do this for such a minor problem. Another option is to call the doctor's office, speak with a secretary (who would then take time deciding about the severity of the problem), have a note left for the doctor, who would then call him back later in the day to reassure him that this twinge doesn't represent a problem with Lipitor. Or the patient might not even ask the question, figuring that the pain is nothing significant, but still remain worried that it's a side effect of his medication and might even stop taking the Lipitor out of concern.

Alternatively, he could write an email describing the problem and receive a reply reassuring him that the pain is not consistent with a side effect from the Lipitor and he should make an appointment to be seen if it continues. Simple, almost effortless, and everyone is satisfied.

In part 3, I'll talk about ways of implementing patient-physician email.

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