Physician-Patient E-mail Disconnect

Only about one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-05, up from one in five physicians in 2000-01, according to a national study released today by the Center for Studying Health System Change (HSC).

The American Health Information Community (AHIC), a recently formed federal commission, has identified secure online communication between physicians and patients -- especially those with chronic conditions -- as one of a limited number of "breakthrough" information technologies targeted for rapid development. Moreover, 80 percent of online Americans would like to communicate with their doctors via e-mail, according to a March 2005 HarrisInteractive Health Care Poll."Despite strong interest among policy makers and the public, most physicians are not rushing to embrace e-mail communication with patients," said Joy M. Grossman, Ph.D., study coauthor and a senior researcher at HSC, a nonpartisan policy research organization funded primarily by the Robert Wood Johnson Foundation.

Based on HSC´s nationally representative Community Tracking Study Physician Survey, the study´s findings are detailed in a new HSC Data Bulletin -- Physicians Slow to Adopt Patient E-mail -- available online. The 2000-01 survey contains information on about 12,000 physicians and had a 59 percent response rate, and the 2004-05 survey includes information from more than 6,600 physicians and had a 52 percent response rate.

"While some health plans are testing payment for e-mail consultations, reimbursement remains limited, and that´s likely a major barrier to physician adoption," said coauthor Allison B. Liebhaber, an HSC research assistant.

Physician-patient e-mail is most common in larger practices. Physicians in staff/group-model health maintenance organizations (HMOs) and medical school faculty practices reported the highest rates of adoption (47% and 43%, respectively), followed by physicians in group practices of more than 50 physicians (29%). In contrast, only about 20 percent of physicians in practices with nine or fewer physicians reported adopting e-mail use, the study found.

However, growth in e-mail adoption essentially stalled in larger practices between 2000-01 and 2004-05. At the same time, smaller practices with nine or fewer physicians did have statistically significant growth in e-mail use.

"The stagnant growth among large practices -- traditionally early IT adopters -- suggests e-mail use is not progressing rapidly," Grossman said.

While some patients are eager to communicate with their physicians via e-mail, not all patients have access to e-mail. Rural, low-income, elderly and African-American consumers are among those less likely to have Internet access and, if they have it, to use e-mail, according to the Pew Internet and American Life Project.

Practices with higher proportions of such patients may move more cautiously to offer e-mail consultations because of more limited patient demand and capability. Indeed, physicians in practices in nonmetropolitan areas, practices with high Medicaid and/or Medicare revenue and practices with a high percentage of African-American patients are less likely to report e-mail is used to communicate with patients, according to the HSC study.

The study cautioned that the findings be considered an upper bound on the proportion of physicians regularly using e-mail in their practices because physicians were asked about e-mail availability in their practice but not whether they actually use the technology or the frequency or intensity of use.