A new study from Boston’s Beth Israel Deaconess Medical Center (BIDMC) offers some early insights into the effects of increasing numbers of emailed communications on doctors, suggesting that reimbursement models and physician workflow may need to adjust to accommodate message management.

The results were published online in Health Affairs.

“BIDMC was one of the first hospitals in the country to create a patient web portal providing a secure platform for patients to view parts of their medical record and send emails to their clinicians,” said lead author Bradley Crotty, M.D. “The portal became available in 2000, so we were able to take a 10-year look at the data and examine the email traffic resulting from this new use of technology.”

From 2000-2010, nearly 50,000 patients enrolled in BIDMC’s patient portal, representing about 23 percent of all patients cared for in the system.

“During the study period we saw a nearly threefold increase in email traffic between patients and doctors,” Crotty said. However, the driver of the increase appeared not to be individual patients sending more messages, but rather more patients signing on to the portal.

“We saw that over time as patients moved through an early adopter phase and settled in to the idea of communicating this way, the overall number of messages per patient didn’t continue to rise, but plateaued over time. However, as more patients enrolled in the portal, physicians’ inboxes increased.”

Crotty also found that some doctors exchanged more email than others. Primary care doctors, for example, represented only 40 percent of doctors in the system, but received 85 percent of the email traffic.

“Surveys have shown that patients desire the ability to communicate with their doctors using email, and on face value it seems to be a good idea,” Crotty said. “There’s a lot of efficiency in being able to send an email and get a response. That type of exchange has the potential to be more respectful of the patient’s time and possibly the doctor’s time too.”

But, Crotty and colleagues ask, in a fee-for-service model of care, how do doctors get reimbursed for email time? And, as the healthcare industry moves toward managed care models, where email exchanges will likely become an increasingly more important tool, how can doctors better incorporate email exchanges into the flow of their already busy work days?

“We’re convinced that technology has an important place in healthcare delivery and that email between clinicians and patients will remain an essential element even as care models move forward,” Crotty said. “But it may require some policy changes and will most certainly involve adjusting the doctor’s day, building in time going forward to meet patient demand for email communication.”

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