Buffalo Grove internist Robert Romanelli was frustrated. His patients would leave phone messages with questions, and when he returned their calls he sometimes had to try four or five times before he reached them.
“Often the answers to their questions were a simple `yes’ or `no,'” he said.
About two years ago, he began telling patients they could e-mail him.
“The initial idea was that patients had e-mail, we had e-mail, and it was just a matter of connecting,” he said.
Today Romanelli receives about three e-mails a day, mostly follow-up questions after office visits.
Most commonly, doctors say, patients write with questions they forgot to ask during an appointment, requests for test results, concerns about medications, requests for prescription refills and to schedule office visits.
Saving time
Charles Swisher, a pediatric neurologist at Children’s Memorial Hospital, said he prefers to see his patients in his office, but e-mails from parents asking for information save time for himself and his nursing staff.
“Parents of a patient may have a question about a new treatment or a diagnostic procedure, and I can give them my opinion as to its value or usefulness,” he said.
According to a recent Harris poll, 77 percent of adults with Internet access would like to be able to e-mail their physicians when an office visit isn’t necessary.
But not all doctors are comfortable with patient e-mail. Many worry that patients may use e-mail when they have medical emergencies or other conditions that warrant a face-to-face visit. More important, they have concerns about security and privacy issues.
Extensive guidelines
A number of medical organizations, including the American Medical Association and the ERisk Working Group for Healthcare — a consortium of national medical societies and liability insurance carriers — have issued extensive guidelines regarding doctor-patient e-mail. Online exchanges also must conform with the federal Health Insurance Portability and Accountability Act (HIPAA), which, in part, requires health-care providers to safeguard access to and disclosure of electronic patient medical records.
The AMA urges physicians to have patients sign agreements indicating they’ve been informed about confidentiality and privacy risks inherent in e-mail communications. The AMA also cautions doctors not to use e-mail for urgent matters, to communicate only with established patients and to keep hard copies of any online messages with patients.
AMA policy board member Joe Heyman, a Boston-area gynecologist, said he posts e-mail guidelines for patients on his personal Web site. He said there’s no foolproof way to guarantee secure messaging.
“Is that really the patient you’re speaking to, a family member or someone breaching the patient’s medical privacy?” he said.
To reduce such concerns, many doctors use e-mail services offered by private networks such as Medem and Relay Health, which offer security safeguards including message encryption. They also require patients to register to access the site and to create user names and passwords.
Medem is a private company whose founders include the AMA and counts nearly 50 major medical societies as partners. The service sets up basic Web sites for physicians that usually include information about their practices, e-mail instructions, information on medical conditions and links to medical resources. Dr. Edward Fotsch, Medem’s chief executive officer, said about 90,000 physicians are part of the network.
Chicago internist David Buyer has a site on Medem, but isn’t yet sold on the concept.
“I think [e-mails] have received mixed reviews,” he said. “I wouldn’t be surprised if it’s not an age-related issue. But it is a great way to document what you said to a patient and what they said to you.”
To charge or not?
One of the most controversial aspects of doctor-patient e-mailing is whether doctors should charge for the convenience. The Harris poll found only half of those who said they wanted to contact doctors online were willing to pay for it.
While Medem doesn’t charge doctors for basic services (Relay Health charges physicians $50 per month), those who bill patients for online consultations through their network must pay the company a small percentage of their fee.
Medem’s Fotsch said at present no health insurance plans reimburse patients for e-mail fees, which he said cost about the same as an insurance co-payment.
Heyman found after he began charging patients $15 per e-mail that interest dropped rapidly — from about 20 messages a month to about one, so he decided to waive the fee.
“There is a convenience and benefit to me above and beyond the income it derives,” he said. “The convenience is that I receive fewer phone calls. I know that patients really like [e-mail access], and it seems a shame to end it just because patients are not willing to pay.”
Romanelli, who said at some point he may charge for patient e-mails, said doctor-patient messaging has made the 12-hour days he often works more efficient. Most important, he said, it allows him to spend more time seeing patients and less time playing phone tag.
“My relationship with my patients is the most important thing, and e-mail allows me to keep in contact with them better than before,” he said. “I can’t say enough about how pleased I am about it.”
