This is a report from Washington, DC-based Center for Studying Health System Change that looks at physician use of e-mail with patients, based on a regularly administered tracking survey of physicians.
The title of the article is accurate; however, I became curious and accessed the data and survey tool (which to their credit, they have made available online (you can access it here)), and checked out some of my findings with lead author Ellyn Boukus to find some interesting and hopeful news, which is the basis of my parenthetical comments in the title.
The report says:
Only 34.5 percent of U.S. physicians providing office-based ambula- tory care in 2008 reported that information technology for communicating with patients about clinical issues via e-mail was avail- able in their practice (see Figure 1 and Data Source). Of the physicians with access to e-mail, fewer than one in five (19.5%) routinely used e-mail to communicate about clinical issues with patients. Overall, only 6.7 percent of all office-based physicians nation- ally routinely e-mailed patients in 2008.
When I first read this report, I thought, “Ok, so physician-patient e-mail is not catching on outside of integrated care systems due to the reasons cited in the paper such as reimbursement, fear, etc etc.” Then I reached into the survey tool and the collected data , and I’ll be honest, said, “wait a second….” Here’s what I found:
1. 26 % of ALL physicians said they spend time every workday e-mailing patients and their families. That’s a lot, because it includes physicians who don’t have system capabilities. Read on…
2. 61 % of physicians who have the capability of e-mailing patients say they are doing it routinely or occasionally. That’s also a lot.
In my dialogue with Ellyn, it looks like I use a different measure for “adoption and use” of physician-patient e-mail.
To help explain this difference visually, here’s the actual survey and the relevant numerical results. Click on any to enlarge (retrieved from here):
I note in their codebook (third image) that they created a “constructed variable” that classified “routine” and “occasional” as “they use it,” which is a different characterization than what the article says. I think this is the more accurate way to match the data to what’s happening in practice among physicians doing this activity.
I would therefore group and classify the data differently based on my experience and data showing that e-mailing between patients and doctors is in fact sporadic.
This is borne out in one study cited in the article, and a newer study not cited in the article. In the newer study, the e-mail interactions are really not that common in the population of people with diabetes and high blood pressure, and that’s as expected. This system (Kaiser Permanente Southern California Medical Group) would without question state, “we have adopted and are using e-mail with patients.” The study goes further to show that they are using patient-physician e-mail to improve quality of care successfully as well.
So, physicians who have the capability of exchanging e-mail with patients and families are doing it. It’s just that the majority of physicians (in 2008) didn’t have the capability to do it (65%).
The trend is unquestionably for more physicians to have this capability, thanks to meaningful use. Physicians and organizations who use these services are advocating for the addition of clinical messaging with patients and families to meaningful use requirements for EHRs (this is not required currently). Patients and families want this (as the article points out quite well), and they have off-the-charts satisfaction with it when they get it, and there’s a study that shows improved quality of care.
The article’s conclusion paragraph says:
Finally, policy makers and researchers might more systematically explore whether e-mail or other secure electronic communication with patients can deliver on its promise to enhance communication, increase patient engagement and satisfaction, improve patient outcomes and quality of care, and boost efficiency. If e-mail does achieve these goals, expanding incentives to encourage e-mail communication between physicians and patients might be a worth- while investment.
Bad news: I am not in agreement with the conclusion above. Good news: I believe this article and data behind it add tremendously to the conversation:
- Patient-physician e-mail really is delivering on its promise, I this this is less a question in 2010 than a statement.
- When physicians have systems that are capable of allowing e-mail to patients, they’re using it.
- This is good news for adding “clinical messaging with patients” capability to meaningful use requirements for EHR stage 2 or 3. Organizations that do it regularly support this idea.
All of this said, Ellyn pointed out to me that in health care we still have the challenge of 78.4% physicians either not having the capability or having the capability and not doing something that their patients and their families want them to. We also don’t know that adding technology to the practices that currently don’t have capabilities will increase use, since the capability is much more likely to be already deployed in health systems friendly to the concept of patients e-mailing physicians.
The interest here is to support physicians in doing things that benefit their patients, and this requires good information. For that alone I appreciate the work of Washington, DC-based Center for Studying Health System Change, their interest in generating conversation about patient-centered care, and the availability of their expertise and data for people with questions. Go #epicenter!
Feel free to post your thoughts in the comments, of course.