Physicians Get The Message-Slowly
September 2005
When health care organizations train physicians on a new information system, they generally demonstrate its many capabilities.
During training on a new patient portal last year, however, Evanston (Ill.) Northwestern Healthcare also ensured physicians understood the technology's limitations.
The three-hospital delivery system designed the portal, called ENHFirst, to enable patient access to their medical records, schedule appointments and e-mail physicians. That last feature initially caused some concern for Evanston Northwestern physicians, who were unsure about how far they should go in an "e-visit" with patients, says A.J. Melaragno, director of interactive marketing.
So before the delivery system unveiled the portal to patients last November, system planners set some limitations on how its e-mail function should be used. They determined that physicians should only offer electronic advice to patients with existing medical conditions.
For example, if a patient already had been treated for the flu and wanted to know when to stop taking a prescribed medication-or get a different one-physicians could offer advice via e-mail. Evanston Northwestern also decided it wouldn't bill patients or payers for the service.
"If we are charging for it, patients are going to expect a diagnosis and some kind of action. But we aren't at that comfort level with e-visits yet," Melaragno says. "We can address existing medical conditions via e-mail and if doctors feel uncomfortable with how far it's going, they ask patients to come in for a visit. It's a strategic decision because of physician concern."
Evanston Northwestern physicians conduct some patient business over e-mail, such as explaining test results. But the delivery system's physicians aren't alone in their hesitation to conduct full online consultations that involve diagnosing problems listed in an e-mail.
Though the number of physicians who use e-mail to communicate with patients is growing, it hasn't reached the level many industry experts predicted, says Keith MacDonald, senior research manager at First Consulting Group Inc., Long Beach, Calif.
Organizations typically offer patient/physician e-mail services to differentiate themselves from the competition and to increase patient satisfaction, he says. While they often achieve their goals, such benefits aren't enough incentive for many physicians to conduct online consultations, MacDonald says.
"For providers, it's all about saving money and increasing revenue," he says. "Physicians who are offering online consultations might be saving a little time and money. But when push comes to shove, there's not enough `skin' in the game for many physicians to want to do this."
No single method
It's been difficult to determine how many physicians are e-mailing patients because there are multiple ways to offer online consultations, experts say.
While some health care organizations have purchased software specifically designed for online communication, others, like Evanston Northwestern, have modified existing technology to support it.
The delivery system purchased its portal tool in 2001 as a component of an electronic medical records system from Epic Systems Corp., Madison, Wis. After implementing the records system the next year, it customized the portal to facilitate patient communication.
To send a message to their physician, patients log into the ENHFirst Web portal. Doctors can access the application from the records system. After the physician responds, the site sends a message to the patient's personal e-mail account asking them to log into the ENHFirst site to retrieve it, Melaragno explains.
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