Dr. John looked again at the computer screen thinking about how to best respond to Pat, one of his patient. He was worried about the growing number of email messages arriving from his patients. Pat kept sending him at least two emails a day, sometimes about mundane billing issues, and sometimes including involved questions about her health. If Dr. John responded to every one of his patients' emails, he might soon find himself sitting in front of the computer screen longer than seeing live patients. Dr. John liked the immediacy and the increased frequency of interaction with his patients but he was also worried about HIPAA: what if his response gets to wrong hands? Would he be liable for breaking privacy laws?
Although over 85 percent of physicians have high-speed Internet access, physician-patient email is only now beginning to traverse the uphill slope of the adoption curve. A recent research of 4,203 physicians, practicing in ambulatory settings, showed only modest advances in the adoption of email communication, and little adherence to recognized guidelines for email correspondence (Brooks and Menachemi, Physicians' Use of Email With Patients: Factors Influencing Electronic Communication and Adherence to Best Practices, J Med Internet Res. 2006 Jan-Mar; 8(1): e2) : While 63% indicated the use of email for communication with correspondents other than patients, only 16.6% had personally used email to communicate with patients and only 2.9% used email with patients frequently.
While physicians seem to adopt email communication in every aspect of clinic management, such as patient registration and insurance billing, several financial and legal issues impede the physicians from regularly using email to communicate with patients. For instance, responding to patient email messages represents an "opportunity cost" to some physicians, especially if the email does not replace other modes of communication such as telephone messages and traditional letters. The aforementioned study indicated that email use correlated with
- physician age (decreased use: age > 61),
- race (decreased use: Asian background),
- medical training (increased use: family medicine or surgical specialty),
- practice size (> 50 physicians), and
- geographic location (urban 17.2% vs. rural, 7.9%).
Remarkably, only 46 physicians (6.7%) adhered to at least half of the 13 selected guidelines for email communication:
- Print email communication and place in-patients' charts
- Inform patients about privacy issues with respect to email
- When email messages become too lengthy, notify patients to come in to discuss or call them
- Establish a turnaround time for messages
- Request patients to put their names or identification numbers in the body of the message
- Send a new message to inform patient of completion of request
- Establish types of transactions, e.g., separate billing from clinical issues
- Explain to patients that their message should be concise
- Remind patients when they do not adhere to guidelines
- Develop archival and retrieval mechanisms
- Include category of transaction (e.g., billing) in subject line of message
- Configure automatic reply to acknowledge receipt of patients' messages
- Request patients to use auto-reply features to acknowledge clinician's message
In summary, both patients and doctors demonstrate increased use of Internet and email communication between the two groups for both administrative (e.g., billing) and personal health issues, but few physicians adhere to email communications guidelines.
Yuval Lirov, PhD, author of "Practicing Profitability - Billing Network Effect for Revenue Cycle Control in Healthcare Clinics and Chiropractic Offices: Collections, Audit Risk, SOAP Notes, Scheduling, Care Plans, and Coding" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Medical Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.
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