In a very interesting study, researchers at Kaiser Permanente in the US found that patients who consult their physicians via e-mail are less likely to visit their physician or to call their doctor's office and as a result could reduce income for physicians whose revenue is generated by direct face-to-face contact. This study presents observations in a US context, however the findings also deserve examination and discussion from a Canadian perspective.
I have used non-secure e-mail to communicate with patients in my practice for the past 4 years. With clear guidelines on use (printed on the back of appointment cards) and on the practice web site, the number of e-mails received has certainly not been overwhelming and in many cases, it is simply a request for an appointment, an e-mail to cancel an existing appointment or a a request for medication renewal. Secure e-mail is the next level up and moves the clinical encounter into a virtual space. However, communicating via e-mail is time consuming and takes time away from direct patient encounters. As a result, without a clear mechanism to reimburse physicians who provide consultation services to patients for secure e-mail interaction, the same is likely to be seen in Canada in fee-for-service practices.
In alternative-payment models of practice e.g. salary or blended models (non fee-for-service), secure e-mail makes perfect sense. If patients can be kept out of the practice (for minor conditions), e-mail is likely to reduce the workload for physicians and staff. However this is only in situations where the physician is reimbursed to provide care for a patient population whether or not that patient is seen face-to-face.
The other issue in Canada is the physician resource crisis. There are a significant number of patients who cannot find a family doctor and are instead dependent on walk-in clinics, urgent care centres or emergency departments for their primary care. If it were possible to reimburse family physicians for providing a certain amount of care via secure e-mail, it may increase capacity in medical practices in order to absorb some of the orphan patients who receive their care from multiple providers in a very episodic fashion.
"Article: Patients who consult with their physicians via e-mail are less likely to visit their physician and less likely to call their doctor's office, according to data from the Kaiser Permanente Center for Health Research, the Portland Business Journal reports. Kaiser found a decline of between 7% and 10% in primary care office visits for patients who e-mail their physicians and a 14% decrease in patient phone calls to doctors' offices. The reduced number of office visits could help save money for employers and insurers, although it also could be financially harmful for medical practices that rely on patient visits for income from insurance reimbursements, the Journal reports.
Kaiser Northwest several years ago began using e-mail as part of a pilot project, and currently, 113,000 Kaiser members in Oregon and Washington state use the Internet and e-mail services as part of their health plan. Patients are becoming increasingly interested in secure e-mail services, and they might pressure clinics to invest in the systems or develop a new business model to pay for the systems, according to the Journal (Moody, Portland Business Journal, 6/29).
What do you think? Is secure e-mail communication with patients a valuable service in Canada? What needs to be put into place in order to make secure e-mail viable and useful in a Canadian setting? To share your thoughts and experiences, please click on the 'Comments' link.