Opportunities to enhance patient and physician e-mail contact

Abstract

The purpose of our study was to evaluate how e-mail is currently used between physicians and patients in an integrated delivery system, and to identify developments that might promote increased use of this form of communication. A paper-based survey questionnaire was administered to 94 primary care physicians. We evaluated the role e-mail currently plays in a physician's typical work day, physician views on the impact of e-mail on phone use and the barriers to increasing the use of e-mail with patients. 76% of physicians surveyed responded. All respondents currently use e-mail. Close to 75% of physicians use e-mail with their patients, but the vast majority do so with only 1–5% of those patients. 50% of physicians believe that up to 25% of their patients would send e-mail to them if given the option, with an additional 37% believing that between 25% and 50% of patients would value this option. The main reported barriers to physician-patient e-mail related to workload, security and payment. Our survey findings indicate that with adequate pre-screening, triage, and reimbursement mechanisms physicians would be open to substantially increasing e-mail communication with patients.

Introduction

Recent studies indicate that 66% of all American adults are now online, either from home, work, or elsewhere [1]. Increasingly, these people have been using the Internet to help manage their healthcare, taking advantage of their computer literacy to access health Web sites and physician web pages. In this way, Americans are becoming more empowered and informed participants in their health care [2]. Patient interest in communication with doctors via e-mail is high. According to a recent Harris Interactive report, 90% of on-line adults in the USA would like to be able to e-mail their doctor [1]. In fact, patients’ desire to e-mail their doctors is so strong that the same survey reported that 37% of all those online would be willing to pay out-of-pocket to be able to e-mail their physicians. However, to date, patient enthusiasm for using e-mail to communicate with their physician has elicited a measured response from physicians.

E-mail use in general has grown rapidly in recent years not only in the USA, but also internationally; between 1998 and 1999, while e-mail use increased 83% in the USA, it increased by more than 100% abroad [2]. We suspect that while the opportunity to increase e-mail communication between patients and physicians exists in many different countries, physician hesitancy to adopt the use of e-mail with patients is probably an international issue. However, the reasons for such hesitancy and the specific barriers to increasing physician-patient email are probably context specific.

It is not unusual for new communications technologies to be adopted slowly. It took until the 1940s for medical professionals to adopt the use of the telephone in clinical practice [3]. While the telephone was met with some resistance, use of the telephone and telefax have since become as integral to a clinician's practice as the chart. Despite slow adoption by many physicians, e-mail with patients promises to become a vitally important tool in clinical medicine. Several studies examining the actual benefits of physician-patient e-mail communication [4], [5], [6]show that these benefits are potentially numerous. For example, 57% of online users expect that they will have fewer frustrations with their doctor's office if they can use the Internet to communicate with the office; 60% report that they often have questions to ask after a visit with their physician that could be handled without a return visit if e-mail were used, and 83% would like follow-up e-mails with their doctors and electronic reminders about preventative care based on their medical history [7]. In addition, 56% report that physician willingness to communicate using e-mail would influence their choice of physician [1].

Importantly, increasing the use of physician–patient e-mail could lead to improvements in overall physician–patient communication. This is salient for a number of reasons: good physician–patient communication with their physicians is important in maximizing therapeutic benefits to patients [8], [9], and has been linked to improved patient adherence, satisfaction, health status, and a reduced need for diagnostic tests and referrals [10].

Despite the potential benefits of physician–patient e-mail, patient demand for e-mail communication with physicians continues to exceed availability. Although the number of physicians that use the Internet and e-mail their patients, or plan to do so, is growing [7], there are still obstacles to further growth including medical liability, workload, privacy and reimbursement concerns. Many physicians are hesitant to use e-mail with patients, given that time spent doing so is not currently reimbursable [11]. According to Medem.com, a website started by the American Medical Association and other specialty societies, more than half of physicians would be willing to engage in e-mail consultation if they were paid for their time [12]; experiments are underway in some healthcare markets to evaluate this practice [13].

To further evaluate the range of obstacles to use of physician–patient e-mail, we conducted a survey of primary care physicians affiliated with Partners HealthCare System, a large integrated delivery system. We also evaluated whether physicians who did not use e-mail differed from those who did with respect to several demographic factors. Studying these physicians’ attitudes towards e-mail use with patients was especially timely since this organization is currently piloting an application called Patient Gateway that allows patients to communicate with their physician's office via the Internet using a secure electronic link. A major goal of Patient Gateway is to improve communication between patients and primary care practices. To maximize the success of this effort, physician concerns relating to electronic communication must be addressed.