News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD
Release Date: October 3, 2007; Valid for credit through October 3, 2008
Physicians – maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;
October 3, 2007 — Patients prefer patient-physician email communication, which takes less time for physicians than does telephone messaging, according to the results of a survey reported in the October issue of Pediatrics.
“The 2001 Institute of Medicine (IOM) report Crossing the Quality Chasm: A New Health System for the 21st Century called for care that is based on continuous healing relationships,” write Paul Rosen, MD, MPH, MMM, and C. Kent Kwoh, MD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. “In its first rule on redesign, the IOM report stated, ‘Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits.'”
The goals of this study were to evaluate the patterns of patients using a patient-physician email service, to measure physician time required to answer a patient question via email vs via telephone, and to assess the satisfaction of families who were provided email access to their child’s rheumatologist.
During a 2-year period, a consecutive series of the families of pediatric patients were offered email access, and the investigators collected data on patient email use. Studied parameters included urgency, subject matter, and volume of the message; time of day of messaging; and timed duration with use of a stopwatch of the pediatric rheumatologist’s email interactions and telephone interactions with patients. After 1 year of enrollment in the patient-physician email service, families were mailed a 12-item satisfaction survey concerning their email experience.
Of 328 families who were offered patient-physician email access, 306 enrolled, and 121 used the service. Of all patient emails sent, 40% were sent during nonbusiness hours, and 5.7% were urgent (notification of disease flare or of new symptoms or parent expectation of same-day response). Only 0.002% of the emails to the physician required emergent attention.
On average, the physician received 1.2 emails per day from patients. For the physician, answering patient questions by email was 57% faster than by telephone. Families who responded to the survey reported that patient-physician email improved access to the physician as well as quality of care, and they did not believe that patient-physician email distanced them from the pediatrician.
“Patient-physician e-mail is a service that patients will use given the opportunity,” the study authors write. “The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service.”
Limitations of the study include lack of generalizability to practices in other pediatric subspecialties or in general pediatrics; lack of measurement of the impact of the email service on the number of telephone calls to the office; survey instrument used to evaluate patient satisfaction not being a validated tool; and only 41% of surveys returned, introducing sampling bias.
“For some physician practices, a staff-based triage system may be more efficient than a non–triage-based system,” the study authors conclude. “However, the comments of the families who used the service demonstrate that PPEM [patient-physician email] is one method of improving communication and providing consumer-driven health care…. Given the nature of family-centered care for pediatric patients, pediatricians and pediatric subspecialists are well positioned to transform health care delivery.”
The Children’s Arthritis Network supported this study. The authors have disclosed no relevant financial relationships.
The 2001 IOM report mandates care based on continuous healing relationships, which implies that patients should have access to care whenever they need it and not only through in-person visits. Email communication may be a low cost, yet effective, method to respond to patient concerns, and 90% of patients surveyed stated that they would like the ability to email their physician.
Although pediatricians are more likely than other physicians to use email communication with their patients, only 30% of pediatricians are using patient-physician email at present. In addition, 37% of patients who use email reported that they would pay out of pocket for the ability to email their physician, and one third reported that they would change their physician to get patient-physician email.
The objective of this study was to assess patient use of patient-physician email as well as physician time spent and patient satisfaction.
- The goals of this study were to evaluate a patient-physician email service used to provide patient access to 1 pediatric rheumatologist.
- During a 2-year period, a consecutive series of 328 families of this pediatrician’s patients were offered email access; 21 declined enrollment (10 because they had no email access, 9 because they preferred to always use the telephone).
- Informed consent noted that email should not be used for an emergency or time-sensitive situation; should be concise, may be forwarded to other members of the healthcare team involved with the child’s care, will become part of the child’s medical chart, response will be sent within 72 hours, and private healthcare information sent through the Internet may be intercepted by hackers.
- Measured outcomes included urgency, subject matter, and volume of the email message; time of day of messaging; and timed duration (with use of a stopwatch) of the physician’s email interactions and telephone interactions with patients.
- After 1 year of enrollment in the patient-physician email service, families were mailed an anonymous 12-item satisfaction survey concerning their email experience.
- Of 328 families who were offered patient-physician email access, 306 enrolled, and 121 used the service.
- Families who responded to the survey reported that patient-physician email improved access to the physician as well as quality of care. They also believed that email facilitated understanding of medical tests, and they did not believe that patient-physician email distanced them from the pediatrician.
- Of all patient emails sent, 40% were sent during nonbusiness hours, and 5.7% were urgent (notification of disease flare or of new symptoms, or parent expectation of same-day response).
- Despite informed consent warning families not to use email to report emergencies, 0.002% (2/848 emails) sent to the physician required emergent attention. Both emails were sent by the same family.
- On average, the physician received 1.2 emails per day from patients. Although the consent form indicated that email responses would be sent within 72 hours, almost all physician responses were sent within 24 hours, and many responses during regular business hours were sent within 2 hours.
- For the physician, answering patient questions by email was 57% faster than by telephone (mean, 132.1 vs 309.2 seconds; P < .0001).
- The email service in this study did not provide for security with encryption technology, which is recommended by the Health Insurance Portability and Accountability Act (HIPAA) policy statement. Patients were reminded through informed consent of the risk for stolen private health information.
- The routing process for the telephone triage system used in this practice could take several hours, depending on the workload of each staff member involved. The email process bypassed the support staff and left physician response time as the only delay.
- Although physicians may be concerned about increased liability regarding email communication with their patients, the investigators concluded that anything that enhances physician-patient communication should decrease the risk for misunderstanding, preventable injury, and liability. They also note that reimbursement for email communication with patients is not widespread, but that the email serves as documentation of the encounter and a copy can be saved to the medical record.
Pearls for Practice
- Families who used a patient-physician email service reported that patient-physician email improved access to the physician as well as quality of care. They also believed that email facilitated understanding of medical tests, and they did not believe that patient-physician email distanced them from the pediatrician.
- Only 0.002% of emails sent to the physician required emergent attention. Almost all physician responses were sent within 24 hours. For the physician, answering patient questions by email was 57% faster than by telephone.
Medscape Medical News 2007. ©2007 Medscape
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