More physicians using e-mail to communicate

It saves time, produces a record

When it comes to improving communicating with patients, "the telephone is no longer adequate," says Daniel Hoch, MD, assistant in neurology and director of neurology operations improvement at Massachusetts General Hospital in Boston, who is running a pilot e-mail program with about 10 patients.

"There are too many calls, and people are not satisfied with a quick answer. The Web-based approach is more convenient, and more information can be given," he says.

The neurology department has had a service for about a year that allows patients to post a message to Hoch on a bulletin board. He answers directly to the bulletin board, and the postings are saved to provide a record of the interaction that is easy to review. The site is password-protected and more secure than standard e-mail, he says.

Hoch uses the e-mail method to answer patient questions, leave instructions for medication changes, and to direct patients to Internet sites that might supply more information.

He says using e-mail has cut the time he spends on the phone with patients by 25% to 50%.

"We’ve generally found it more efficient than phone calls. There is the ability to take care of business from remote sites, to do so at odd hours without worrying about waking someone up. And it is often faster than phone tag," he says.

Another benefit: Since e-mail messages can be printed out, there is a written record for both the patient and the physician.

Hoch is on the cutting edge of using a technological tool that could transform the day-to-day practice of medicine. Only about 5% to 10% of physicians currently correspond with their patients by e-mail, up from 1% to 2% one year ago. However, experts predict this number will rise quickly as patients used to e-mailing business associates, friends, and family demand the doctors respond to their e-mail inquiries.

"The small group of clinicians who routinely use provider-patient e-mail say that it has revolutionized their practice in very positive ways," says Tom Ferguson, MD, an Austin, TX-based consultant. "In many cases, they can avoid the need for a clinic visit by an on-line exchange. And there is always a full record of the on-line conversation, so it can automatically become a part of the patient’s medical record."

Ferguson says 25% to 30% of doctor-patient e-mail deal with follow-up questions after an office visit, a perfect example of the benefits of e-mail. "It’s wonderful as a doctor to say, Send me an e-mail in 10 days, and let me know how you’re doing.’ You usually don’t know what happens to the patient. Think how good that could be for your clinical expertise."

Paul M. Ford, MD, an assistant professor of medicine at Stanford University in Palo Alto, CA, who practices internal medicine, has been using e-mail with his patients for about five years. "E-mail unloads a lot of the administrative stuff you have to do in medicine, " he says. "I really believe if we had more patients using e-mail, it would decrease our overall practice costs. We wouldn’t need so many people to answer the telephone, so many people in the file room moving charts around. Also, patients would feel more connected to the practice, which could help financially in the long run."

Ford’s practice of 10 physicians has a central e-mail address and a software filtering program that helps automatically route messages to the appropriate people. An automatic reply is sent to notify patients their message was received and who will take care of their request. Sometimes, the practice adds standardized reminders to the automatic message such as information about flu shots. Many of the messages involve prescription refills, appointments, and specialist referrals that can be handled by someone other than a doctor. Physicians only give out their private e-mail addresses when they feel it’s appropriate.

(For more information, the American Medical Informatics Association Internet Working Group, has developed "Guidelines for the Clinical Use of E-mail with Patients." The guidelines are available at www. amia.org/pubs/pospaper/positio2.htm.)