Ok, that’s it. In today’s USA Today, Kim Painter suggest the the time worn charge that physicians are technophobes – physicians are not “Web MDs” (which is a catchy headline, by the way! 🙂 ).
There are many, many reasons why email is not on the top of physician’s to do list. Flat and declining reimbursement and income and improving and measuring quality of care and two issues on everyone’s desk. Then we turn to DHHS, who has exhibited skittishness over the years when dealing with online issues. They are right, of course – there have been enough incidents of hacking to give anyone pause. There are also solutions now, using a secure web site to “meet”. Medem (www.Medem.com) is one provider that any physician can use. There are insurance carriers that are starting to pay for “e-consults”.
For certain matters, such as prescription refills, email could be an ideal time saver for everyone involved. I can refill a prescription from our mail order pharmacy online – the site displays all prescriptions, both current and in need of reauthorization, by familty member. Click, click – it’s reordered, or Medco Health will contact the physician for a reauthorization. (Well, except for the notable exception of one practice we deal with who doesn’t do faxes. But I digress).Email has another advantage – the communication is documented as to who said what, and when they said it.
Physicians are realistically reluctant to take on another service for which they probably won’t get paid, and for which there is a risk that they will only add to their time burden. The business pages are fuill of stories of how employees feel overwhelmed by email. Will the same happen to physicians? I think not, if for no other reason than there are cost and skill barriers to being able to use email. Nevertheless.
In the article, a patient said that email represents “the patient’s own words, coming straight from me.” OK, but sometimes some good folllow-up questions will lead to a better message from the patient. But that could also be dealt with by staff who can screen and triage email, the same way they screen and triage phone calls.
My take: look at email for prescriptions, maybe even lab and other test results. Give people a “checkpoint”, such as “if we don’t confirm with 24 hours, resend.” Do not use email for same day or sick calls. Every telephone answering message I’ve ever heard always starts with “if this is an emergency. call 911 or go to the emergency room.”
I wrote a letter as soon as I saw this article this morning, which is included at the end of this post. In Painter’s very nice response, she made an important point, “Research by Roter [Debra Roter of Johns Hopkins] and others (some yet to be published) shows e-mail messages contain as much or more warmth as in-person exchanges between doctors and patients — and that patients actually provide more information in e-mails.
I’d llike to hear from practices who are using email and/or other online tools – we can be anonymous.
Here’s my letter:
I’ve been in healthcare for 30 years, have run and consulted to medical practices, and currently write the “Physician Business” blog for All Business.com. If I read one more article about why physicians are technophobes, I’m going to scream.
Here’s my scream for today:
1. Physicians are around technology all day, and they very well understand the power of technology.
2. In medical care, unlike any other industry, this really is a matter of life and death. The “blue screen of death” is not acceptable, and can put a patient in real danger. That patient could be you.
3. DHHS has, for years, taken a very cautious stance regarding online communication with patients. There is a way around the concerns, such as a the system run by Medem (www.medem.com). There are laws that govern physician – patient communication.
4. Until very recently, insurance carriers did not pay for email time.
5. Email is unreliable. I’ve had numerous occasions when email has crashed, been lost, and so on.
6. Physicians get enough “advertising” directed to them. Release email, and it is likely to be worse.
7. Email is less personal – most people have trouble communicating well in writing. I teach the introductory class at the University of Phoenix online, and one of the first things students have to grapple with is to learn to communicate in writing and work in an online environment. Most patients don’t tell their physician everything when they’re in front of the physician – email is a wall to hide behind. Some can or will use email well, and yes, personalities often do come out online. One of the disadvantages of online is that we lose out on visual and aural cues. With email, with lose the aural cues from the patient’s voice.
In your article, you used Kaiser Permanente as an example. Well, Kaiser is a unique critter in the healthcare world, where physicians, hospitals and health plan are pretty well integrated. Not so in the rest of the world.
It will come. The spread of secure email handling systems, clearer and consistent rules on payment for e-consults, etc will help. But please, do not spread the lie that physicians are technophobes. Your article was on sided to people who have stuff to sell without understanding the workings of the people they want to sell their product. Jim Clark, the co-founder of Netscape, set out to save the healthcare industry with Healtheon. He fell on his face. Now Steve Case is going to save us (Revolution). Gee, thanks.
I firmly believe that healthcare needs to use email and the web more often. It’s another change to grapple with in an industry which is being slammed from all sides, so online work gets put aside in favor of other business tasks. I would do the same.
I think you will see a “tipping point” reached soon – within the next two, maybe three years.