Cost-effectiveness of clinical messaging, Markle convenes around PHRs, More on Computer use

PCHIT links for December 17th:

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Clinical eMessaging is not as costly as phone calls! We looked at this in the early 2000s when our clinic was a pilot for messaging for our national website, Bottom line: we found that if the clinician took the time to document the message for the patient, then being able to click 'send,', rather that ask the MA or nurse to call the patient, saved the average 1.5 attempts it takes to reach the patient by phone, not to mention the rewording of the message by third parties, and the occasionally 1-2 days it may take to actually reach the patient by phone.

Again, we are better off as a profession by askinig people how they prefer to receive health information: many prefer a phone call if any change in behavior is indicated. Many prefer a phonecall, confirmed by a follow up letter or email.

Finally, we need point of care tools for assessing health literacy: literacy level is NOT implied by willingness to do eMessaging, which may be influenced by a variety of factors: hearing ability, ability to travel to appointments, work schedule, etc, all which make the visual immediacy of the internet and eMessaging more appealing. I have received many eMessages which were barely interpretable, except by a clinician who knows the patient and current care issues well.

We found that being able to do eMessaging has made care accessable to many who have a hard time coming to the office, or expressing themselves verbally in the face-to-face situation. It's kind of like ATMs: no longer an option for the banks. EMessaging is fast becoming what the phone was at the end of the 1800s–one additional access point to health care.

Shortly after launching our EPIC medical record, we revised our letter writing capabilities to support outbound results reporting. On seeing the quality of the letters, our staff let us know that they would appreciate much clearer messages written for them when calling our patients on our behalf–bottom line, using plain English, at the 4-6th grad level, with complete sentences, empowered everyone in the care process to help the patient.

Email is not an option, it is here to stay, and should be one in an array of communication tools we use to support our patients in taking reponsibility for their health.

Happy Holidays to all!!

Ted Eytan, MD