E-mail Communications in Family Practice What Do Patients Expect?

,

Original Research

E-mail Communications in Family Practice What Do Patients Expect?

J Fam Pract. 2001 May;50(5):414-418

By

Glen R. Couchman, MD

References

1. Costello R, Shaw A, Cheetham R, Moots RJ. The use of electronic mail in biomedical communication. JAMIA 2000;7:103-05.

2. Fridsma DB, Ford P, Altman R. A survey of patient access to electronic mail: attitudes, barriers and opportunities. Proc Annu Symp Comput Appl Med Care 1994;15-19

3. Mold JW, Cacy JR, Barton ED. Patient-physician e-mail communication. J Okla State Med Assoc 1998;91:331-34.

4. Sands DZ, Safran C, Slack WV, Bleich HL. Use of electronic mail in a teaching hospital. Proc Annu Symp Comput Appl Med Care 1993;306-10.

5. Nettelman MD, Olcahnski V, Perlin JB. E-mail medicine: dawn of a new era in physician-patient communication. Clin Perform Qual Health Care 1998;6:138-41.

6. Neill RA, Mainous AG, Clark JR, Hagen MD. The utility of electronic mail as a medium for patient-physician communication. Arch Fam Med 1994;3:268-71.

7. Mandl KD, Kohane IS, Brandt AM. Electronic patient-physician communication: problems and promise. Ann Intern Med 1998;129:495-500.

8. Kuppersmith RB. Is e-mail an effective medium for physician-patient interaction? Arch Otolaryngol Head Neck Surg 1999;125:468-70.

9. Singarella T, Baxter J, Sandefur RR, Emery CC. The effects of electronic mail on communication in two health science institutions. J Med Syst 1993;17:69-86.

10. Badal P. Email contact between doctor and patient. BMJ 1999;318:1428.-

11. Provider-patient e-mail could transform medicine. Healthc Benchmarks 1999;6:53-55.

12. The Net. Medical email has benefits, risks. Available at:news.cnet.com/news/. Accessed January 20, 2000.

13. E-mail contact between doctor and patient. Med Pract Communicator 1999;6:5.-

14. Kane B, Sands DZ. for the AMIA Internet Working Group. Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail. Guidelines for the clinical use of electronic mail with patients. JAMIA 1998;5:104-11.

15. Taylor K. The clinical e-mail explosion. Physician Exec 2000;26:40-45.

16. SPSS Inc. Statistical package for the social sciences for Windows. Version 8. Chicago, Ill: SPSS Inc; 1996.

17. Dallas Business Journal, August 28, 2000. [Author: Please provide author and title of article]

18. University of Michigan. University of Michigan study finds patients and physicians encourage E-mail use. Available at:www.med.umich.edu/choices/intel.html. Accessed November 27, 1999.

19. Braithwaite W. HIPAA and the administration simplification law. MD Comput 1999;16:13-16.

20. Amatayakul M. HIPAA update: achieving compliance with the new standards. MD Comput 2000;17:54-56.

21. Kalsman MW, Acosta DA. Use of the Internet as a medical resource by rural physicians. J Am Board Fam Pract 2000;13:349-52.

22. US Department of Health and Human Service. Healthy people 2010. Washington, DC: US Department of Health and Human Service; 2000.

OBJECTIVE: Many health care providers and patients are exploring the feasibility of using E-mail to address a variety of medical issues. We wanted to determine the proportion of our patient population with E-mail access, determine their willingness to use this technology to expedite communication with health care providers, and assess their expectations of response times.

STUDY DESIGN: A cross-sectional, in-person prevalence survey.

POPULATION: Patients (n=950) with scheduled appointments to see a primary care provider in 6 of 18 family practice clinics in a large health care delivery system in central Texas.

OUTCOMES MEASURED: The proportion of patients with E-mail access, their willingness to use it, and their expectations regarding the timeliness of responses to their E-mail queries about selected clinical services.

RESULTS: Overall, 54.3% of the patients reported having E-mail access, with significant variation among the 6 clinics (33%-75%). Reported areas of strongest desire for using E-mail were to request prescription refills (90%), for nonurgent consultations (87%), and to obtain routine laboratory results or test reports (84%). Patients’ expectations regarding the timeliness of responses to their E-mail queries varied by clinical service. For laboratory results, their expectations were: less than 9 hours, 21%; 9 to 24 hours, 53%; and more than 24 hours, 26%.

CONCLUSIONS: Most patients attending family practice clinics in central Texas have E-mail access and indicate they would use it to request prescription refills, for nonurgent consultations, and to obtain routine laboratory results or test reports. Regardless of sex or race, patients have high expectations that these tasks can be completed within a relatively short time.

E-mail use has been reported in a variety of broad areas, including biomedical communication, general patient surveys^2,3 and medical practice^4-8; it is also used by several institutions.⁹ Approximately half of all US adults report that they currently use E-mail at home or at work, and as many as 40% of patients would use E-mail to communicate with their physicians.¹⁰ Experts estimate that 5% to 10% of physicians are already communicating with their patients by E-mail.¹¹

There are many potential benefits to E-mail in medical practice.^10,12 It allows for efficient asynchronous communication. It eliminates phone tag, and the caller does not incur long-distance phone charges. E-mail is also a good marketing tool and lends itself well to linkage with patient education Web sites. Another advantage is improved documentation. By simply printing and including or copying all E-mail communications in the medical record, excellent documentation of the provider-patient discourse is obtained. This form of provider-patient communication may be very beneficial financially in capitated environments, where simple medical problems can be addressed without an office visit.

Along with these benefits, however, come significant potential disadvantages.^3,12,13 Many physicians are afraid that E-mail would allow patients too much access, and consequently they are reluctant to embrace this innovative communication tool. There are related concerns that patients will barrage their physicians with excessive E-mails on trivial matters. It could become another physician hassle factor of practice and create one more thing to do at the end of the day. Also, there are genuine fears that patients will think of E-mail as a hot line to the physician’s office and inappropriately use it for emergent situations, creating additional liabilities for the physician and staff. There are also very real concerns about privacy and security: How can this exchange of information between providers and patients be protected and kept confidential if it is on the Internet?

Although it is generally agreed that some guidelines are required to manage and regulate E-mail communication between patients and their health care providers,^14,15 it is equally important to assess the actual desire for this technology in specific practices. We conducted a needs assessment for E-mail communication between family physicians, other health care providers, and their patients attending 6 family practice clinics in central Texas.

Methods

Study Design and Setting

We performed a cross-sectional, in-person prevalence survey using patients with scheduled appointments to see a primary care physician in 6 of the 18 clinics of the Scott & White Healthcare System in central Texas: Northside Clinic and Santa Fe Clinic in Temple, Belton Clinic, Killeen Clinic, Bryan/College Station Clinic, and Waco Clinic. Temple, Belton, and Killeen are all located in Bell County, while Bryan/College Station is located in Brazos County, the site of the main campus of Texas A&M University. The Scott & White Institutional Review Board reviewed the study protocol.

Study Participants and Data Collection

A concerted effort was made to enroll all patients who presented to each of the 6 clinics on preselected days for the surveys. The days differed by clinic and were selected to enroll a specified number of patients according to clinic size for a total of approximately 1000 subjects. The newly opened Northside Clinic was an exception.