Let me start this note by stating my opinion about the use of email by physicians -- I would not select a physician for my personal care who was unwilling to communicate with me, on occasion, via email. My reason for this is relatively simple. Communicating with my personal physician is frequently much more efficient with email, and this applies to both myself and to the physician. Below is an excerpt from a recent article about this topic (see: E-mail good for patients, not so much for docs). Boldface emphasis is mine.
Patients who use e-mail to communicate with their medical providers are apt to visit the doctor's office less and are also less likely to phone the doctor's office, according to recent data from the Kaiser Permanente Center for Health Research. Fewer medical office visits could spell health cost savings for health plans, for employers that buy health insurance and ultimately for patients. Prepaid health systems like Kaiser also save by avoiding unnecessary office visits. However, a drop in patient visits could mean less income for traditional medical practices that rely on patient visits to be reimbursed by insurance, even if the office was able to save on staffing from fewer phone calls. Kaiser's research showed a 7 percent to 10 percent decline in primary care office visits among its patients who use e-mail, and a 14 percent reduction in patient phone calls to primary care offices.... Most primary care physicians can scarcely afford to lose more revenue, having already seen a 10.2 percent decline in real income nationally between 1995 and 2003....But patients are increasingly interested in using e-mail services, and may come to chose providers based on whether they offer the service.
So, how do we get out of this bind that physicians are not appropriately reimbursed for responding to their patients' emails. Well, first of all and to restate the obvious, the healthcare providers need to lobby the insurance companies to provide reimbursement for "email consultations" at an appropriate rate. Documentation of all email exchanges should be automatically added to a patient's office EMR for reasons of quality and medical liability. These files will provide ample evidence of the transaction for billing purposes.
Physician office practices and health systems should advertise the names of those PCPs and specialists who are willing to communicate with their patients via email. My guess is that such practices will prosper. However, I further believe that email communication between a physician and patient should be managed, which is to say it should be conducted using a web application on a secure server controlled by the medical practice or health system.
Such communications should be structured in such a way that the reason for the email communication is readily obvious and the patient should be given a limited amount of space in the web-based email application to avoid meandering. Such email systems could also provide ready access to reliable medical resource materials so that some patient questions can be answered before the email is actually generated. Finally, I believe that the email from patients to physicians should be pre-screened by nurses in the practice such that many of the responses will not require the prolonged attention of the physician. For all email correspondence, however, the physician should add a personal note to the response to indicate that he or she has reviewed the correspondence.
Of some interest will be the fact that I tried using various web search engines to turn up some references to "secure patient email" with little success. Many of the best articles on the web were 3-4 years old. For some reason, secure patient email, which makes perfect sense to me, seems to have hit a brick wall. Perhaps, as the article above indicates, the lack of reimbursement has brought progress in this area almost to a halt.
:: Update on 8/2/2007 @ 1:35 p.m.
John Norris points out in a comment that what I referred to in my note as patient email is now called web messaging, which explains why I was drawing a blank with my web searches. Here's the result of a Google search using the terms web messaging and patient. I got 925 hits. Thanks, John.
I think you are not seeing more recent papers on "secure patient email" because web messaging is now the standard to refer to it (e.g., Kaiser.) Email was recognized as not being as good a solution.
Some folks call web messaging "email" probably because it can be a similar experience and providers need to be paid for answering it!
Posted by: John Norris | August 02, 2007 at 11:12 AM