Researchers have looked at the ways in which patients and healthcare providers communicate, and what they have found is that the relationship a clinician has with a patient may have a greater impact on patient satisfaction than the technology used.

In a survey of 149 Mid-Atlantic primary care providers, Regenstrief Institute and Johns Hopkins University researchers wanted to know what modes of electronic communications clinicians used with their patients over a six-month period—including email, cell phone and text messaging—and how these interactions correlated with patient satisfaction.

Overall, physician use of cellphones to communicate with patients was higher than use of email. In fact, fewer than half of the clinicians surveyed used email to communicate with patients. However, 70 percent of providers surveyed indicated that they would use email to reply if a patient emailed them first.

“For patients, that physicians would use email if prompted by their patients indicates patient power in patient-provider communications and that patients should be empowered to ask their providers about communicating electronically in a way that works best for both parties, although few physicians will offer to unprompted,” states the study published in the peer-reviewed European Journal for Person Centered Healthcare. “For providers, as patient use of electronic communication increases, they need to consider how best to communicate and deliver care electronically and overcome existing concerns.”

While technology is convenient for facilitating patient-physician communications, the providers surveyed had concerns about patients potentially missing urgent messages, as well as patients possibly misunderstanding information contained in electronic messages. In addition, physicians were concerned about the amount of time they spent communicating with patients electronically and about the security of the data.

“One of the highest concerns for providers was around the potential for patient misunderstanding of electronic messages,” says Joy Lee of the Regenstrief Institute’s Center for Health Services Research, who led the study. “When they’re not having face-to-face communication, it’s a lot harder to gauge patient understanding. Another concern was that an important message might be missed, slipping through because a provider didn’t check their email or the patient doesn’t see a message come through in time.”

Joy Lee

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Clearly, Lee adds that patient-physician communication cannot rely exclusively on technology. She contends that the interactions between clinicians and patients have to be complemented with in-person relationship.

“It’s important for patients and their doctors to have face-to-face conversations during office visits about their electronic preferences so they can figure out how to make this relationship work electronically, because there are a lot of advantages to electronic communication,” notes Lee.

Because the survey was conducted prior to clinic implementation of a new electronic health record system with secure messaging capabilities, that particular technology was not a part of the study. However, Lee says there are implications for clinicians who use secure messaging and their patients.

“Having secure messaging is obviously great in that it provides a lot more security for the data that is being transmitted, which provides peace of mind for both patients and providers,” she concludes. But, according to Lee, there remain the underlying questions of the patient-doctor relationship and how best to establish these communications.

"With the move to secure messaging by health systems and medical groups, it's no longer just about adoption,” Lee concludes. “It’s about how we address patient and physician concerns to make electronic communication work for both.”

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