You've got mail: 8 findings on physician-patient online communication

While the convenience of email may be conducive for patients, physicians are often concerned the impact of online communication will be a burden on their time, productivity and reimbursement, according to a recent study in Health Affairs. Despite patients' interest, recent data suggests only 9 percent of physicians offered a patient portal that could allow secure messaging.

The study tracked email behavior between patients and physicians between 2001 and 2010 within Boston-based Beth Israel Deaconess Medical Center health system after it launched its patient portal, PatientSite, in 2000. Affiliated physicians who used the health system's EHR were eligible to participate in PatientSite, and the physicians did not receive any reimbursement for using secure messaging.

Data, trends and behavior regarding email communication between physicians and patients is shown below, according to the study.

  • By the end of 2010, 49,778 patients of the 70 participating practices and 272 participating physicians were enrolled in the patient portal. This represented 22.7 percent of the patients seen within the health system in 2010.
  • Of the enrolled patients, 36.9 percent sent at least one message to their physician in 2010.
  • Primary care physicians, representing about 20 percent of all eligible physicians, accounted for 48 percent of physicians who participated in secure messaging.
  • About 85 percent of patient messages were sent to primary care physicians.
  • Enrolled patients were predominantly female (61 percent), white (73 percent) and commercially insured (87 percent). The average age of patients when they enrolled in the patient portal was 43.
  • Over time, the growth in the number of enrolled patients has steadily increased despite a plateau in the number of participating physicians.
  • Physicians cumulatively received 11.9 messages per month in 2001. This number nearly tripled by 2010, with physicians receiving 32.9 messages per month. According to the study, this increase was caused by increasing patient enrollment.
  • Patients typically sent messages in the morning, though they sent 37.5 percent of their messages during "off hours," including after business hours were over, with 10 percent of messages sent out on the weekends.

According to Health Affairs, managing patients outside of visits through electronic communication can enhance care coordination, enable physicians to delegate aspects of care to a team and use their time more efficiently. However, innovative reimbursement models may be necessary to incentivize physicians to use secure messaging with patients. Additionally, accounting for the amount of time that will be necessary to dedicate to online communication will be important, according to the study.

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