In HDM’s Executive Session feature in the October issue, Elizabeth Gartner spoke with Joe Scherger, a medical home pioneer, who has launched a practice based on electronic communication between physicians and patients.

Scherger got his first e-mail address in the late 1980s, when he was part of a leadership development program funded by the Kellogg Foundation that included an e-mail-based discussion forum. He was fascinated by the possibilities. In the late 1990s he began offering his patients lab results via e-mail, as well as the usual phone and mail options. "Four out of five said, 'Wow, e-mail would be great!' and I realized this was a breakthrough form of communication that was going to be a very big deal," he says.

He started giving his e-mail address out to every patient who asked and has never looked back. In 2009, he launched a medical home practice called Eisenhower Primary Care 365 that hinges on electronic communication between physicians and patients, who pay an annual membership fee for 24/7 access.

While the patients have the standard co-pay for office visits, they have fewer of them, since much routine care is handled via a patient portal or on the phone. The office visits are longer than usual-30 to 60 minutes-because they're mostly used when care gets complicated. Over the past five years, the program has grown to 14 physicians and 6,300 patients. Average patient satisfaction scores are at 99 percent and up, and the physicians' salaries-a percentage of their gross revenue plus a bonus for meeting quality and patient satisfaction targets-are well above the average for primary care.

On 24/7 availability

I'm sitting here away from the office at a conference. My patient care coordinator just e-mailed me the CT scan results of a patient that we're working up, and I can message the patient back with good news. I was just given another patient's blood sugar readings and I'm going to adjust her meds.

On e-mail

There's a lot of controversy right now about what e-mail does to the number of office visits. Greenfield Health (the pioneering Portland, Ore., medical home practice on which Eisenhower 365 is modeled) shows about the same number of visits. Kaiser and Group Health have been able to reduce office visits by 25 percent. Our experience varies some, but I have clearly had a reduction in office visits because of doing e-visits.

On IT infrastructure

We'll be looking at a new EHR in the next year. Our practice model is ahead of our IT solutions, and we've struggled at getting our EHR to do the quality reporting that we need. Our patient portal isn't integrated with our EHR, and we have to cut and paste between the two. No. 1 on our wish list is having the portal embedded in our EHR, and No. 2 is the ability to do population medicine well.

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