Patients like medical practices' use of electronic communications, but roadblocks to widespread use remain; © panthermedia.net/Ioana Davies
Patients like it and so do health organizations, but electronic communications in clinical care will likely not be widely adopted by primary care physicians unless patient workloads are reduced or they are paid for the time they spend phoning and emailing patients, both during and after office hours.
Those are some key conclusions of an in-depth examination by investigators at Weill Cornell Medical College of six diverse medical practices that routinely use electronic communication for clinical purposes.
"Leaders of medical groups that use electronic communication find it to be efficient and effective - they say it improves patient satisfaction and saves time for patients. But many physicians say that while it may help patients, it is a challenge for them," says the study's lead author, Doctor Tara F. Bishop.
"The lack of compensation is one issue, and another is that unless the practice takes steps to reduce a physician's daily workload of patients, communicating with patients is extra work that makes some doctors feel that their day can never end," she says.
Still, pressure from patients and from practice management may ultimately force physicians to communicate with their patients via electronic health records or secure email, Bishop adds. "I think there are ways to make a transition to electronic communications in health care work. Our study offers some good examples, but I still think we have a long way to go before physicians routinely email their patients."
The push for electronic communications has been widely endorsed as a means to improve quality of care by, for example, emailing test results to patients, or managing clinical conditions without requiring a time-consuming and costly office visit. Still, few physicians use it. By 2008, the latest year for which figures are available, less than 7 percent of physicians regularly communicated with their patients electronically.
Bishop sought not to conduct a national survey of use of electronic communication in doctors' offices, but to investigate how different practices use it, how successful they are, and what barriers they face.
She and her team interviewed leaders of 21 medical groups, and also interviewed the health care staff, including physicians, in six groups that use electronic communications extensively, but varied in their approach. Five of the six medical groups were large - four had more than 500 physicians and one had 115 physicians. The sixth had 15 physicians within a large academic medical center. None were affiliated with Weill Cornell.
The leaders said they started electronic communication programs to improve access to care and communication with their patients. All six practices used the program to communicate test results, to allow patients to request medication refills, appointments and to ask questions of their doctors. Three practices used nurses, medical assistants or case managers to triage messages from patients; in the other three practices, patients could email nurses for refills or the front desk for appointments, but they could also email their physician directly. The volume of emails that reached physicians in the six programs varied from five to 50 daily.
MEDICA.de; Source: Weill Cornell Medical College