E-mail between patients and docs slow to catch on

Physicians concerned about billing, quality of care

Only about one in four physicians in the United States use e-mail to communicate clinical information to patients, and one reason may be a lack of effective means of billing for e-mail time. But some say they don't yet know enough about what quality of care can be delivered via patients' e-mail inboxes.

These were among findings released recently by the Center for Studying Health System Change (HSC). The report states that one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-2005, up from one in five physicians in 2000-2001.

"Despite strong interest among policy makers and the public, most physicians are not rushing to embrace e-mail communication with patients," according to Joy M. Grossman, PhD, a senior researcher at HSC and coauthor of the study.

Among policy makers pushing information technologies such as e-mail for communication between patients and health care providers is the Bush administration, which two years ago formed the American Health Information Community, a branch of the U.S. Department of Health and Human Services. Additionally, 80% of e-mail-using Americans surveyed in a 2005 HarrisInteractive health care poll said they would like to be able to communicate with their doctors via e-mail.

The survey on which Grossman and her colleagues based their report polled members of the American Medical Association and American Osteopathic Association. Their findings are included in the HSC data bulletin "Physicians Slow to Adopt Patient E-mail," available at www.hschange.org.

The authors write that while some health plans are testing potential mechanisms for obtaining payment for e-mail consultations, reimbursement at this time remains limited, posing a major barrier for physicians, the authors write. A few practices are experimenting with charging patients directly, but whether and how much patients will be willing to pay out of pocket is unclear, they add. Moreover, implementing a secure messaging system is more costly than using unencrypted e-mail, and physicians are less likely to make such an investment without payment for electronic consultations, the authors conclude.

In addition, some physicians fear e-mail will add to their workload instead of replacing face-to-face or telephone consultations. While some studies have shown e-mail can improve physician efficiency and patient satisfaction by providing more timely communication, the authors report, even less is known about the effects of e-mail use on quality of care.

Doctors in larger practices say they use physician-patient e-mail more often than physicians in smaller groups. Physicians in staff/group-model health maintenance organizations (HMOs) and medical school faculty practices reported the highest rates of adopting e-mail use (47% and 43%, respectively), followed by physicians in group practices of more than 50 physicians (29%). In contrast, only about 20% 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 2000-2001 and 2004-2005. 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, according to the HSC. Rural, low-income, elderly, and Black consumers are among those less likely to have Internet access and, if they have it, to use e-mail, Grossman points out.

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