Wanted: Internet Savvy Docs

Edition: April 2002 - Vol 10 Number 04
Article#: 1206
Author: Laura Thill

Are your customers afraid of the Internet, or do they recognize its value as a time-saving, efficient tool for communicating with patients?

The benefits of using e-mail and web sites to link the physician and patient are clear: Communication can be timely and efficient, at little cost and inconvenience to the physician. E-mails permit physicians to quickly deliver test results and follow-up instructions, or even pass along educational materials. Patients can reach their physician easily and directly, without the frustration of being placed on hold by a receptionist or receiving inaccurate information by a third party over the phone. From the doctor's vantage point, e-mails can be printed out and attached to patients' charts for better record keeping.

For Internet communication to run smoothly and effectively, however, both physicians and their patients must consent to following guidelines that address patient privacy and confidentiality issues, as well as physician and patient security.

On one hand, patients can seek important answers from their doctor, such as investigating whether a particular blood test will require fasting, or confirming side effects from a certain medication. On the other hand, though, patients may worry that their e-mails are read by others besides their physician, or they may discover the Internet is merely an advertising tool for their doctor. Conversely, physicians may be deluged by irrelevant or unnecessary communications.

The American Medical Association has issued the following guidelines for physicians to protect their interests, as well as those of their patients:

Communication Guidelines
•        Establish turnaround time for messages. Be careful about using e-mail for urgent matters.
•        Inform patients about privacy issues.
•        Establish types of transactions permitted over e-mail.
•        Instruct patients to put the category of transaction in the subject line of the message for filtering.
•        Request that patients put their name and ID number in the body of the message.
•        Configure automatic reply to acknowledge receipt of messages.
•        Send a new message to inform patients of completion of a request.
•        Request that patients use the autoreply feature to acknowledge reading the clinician's message.
•        Develop archival and retrieval mechanisms.
•        Maintain a mailing list of patients, but do not send group mailings where recipients are visible to each other.
•        Avoid anger, sarcasm, harsh criticism, and libelous references to third parties in messages.

Medicolegal and Administrative Guidelines
•        Physicians should develop a patient-clinician agreement for the informed consent for the use of e-mails. Agreement should contain the above communications guidelines, and should:
1. Provide instructions for when and how to convert to phone calls or office visits.
2. Describe security mechanisms in place.
3. Hold harmless the healthcare institution for information lost due to technical failures.
4. Waive encryption requirement at patient's insistence.
5. Perform weekly backups of e-mail onto long-term storage.
6. Commit policy decisions to writing and electronic form.

Change Takes Time
It's not so much that physicians are resisting newer technologies such as the Internet. But, physicians will not latch onto something simply because it's new, says Deloitte Consulting in the Jan. 25, 2002, edition of its Taking the Pulse series, “Physicians and Emerging Information Technologies. While most physicians use the Internet, if this service disappeared, they would continue their medical practices as they always have, according to Deloitte Consulting. It's not that the interest in this technology is lacking, but physicians “have not found the applications or services that demonstrate clearly how the web can help them increase professional revenues, reduce expenses, save time, or improve the quality of care for patients (Taking the Pulse, “Physicians and the Internet,'' Sept. 2001).''

In its 2001 Taking the Pulse survey, Deloitte focuses on three areas that demonstrate physician use of the Internet:
•        Numbers of physicians using the Internet, and to what extent.
•        The nature of physicians' online activities.
•        Physician attitudes and expectations about the value of the Internet and its impact on their clinics.

As many as 90 percent of the 1,200 physicians interviewed (the sample was obtained from the American Medical Information database) said they had relied on the Internet to some extent over the past year. Eighty-two percent of participants described their use of the Internet as weekly; 55 percent said they rely on it daily. For the most part, physicians go online to access journals, visit medical sites, locate patient education material, or talk to colleagues, according to Deloitte Consulting.

Physicians surveyed were found to be interested in physician-consumer Internet communication, in part due to patients' desire to have e-mail access to their doctors. Tables 1 and 2 (on pg. 52) show how the sample of physicians feel about – and rely on – e-mail communication with their patients.

One thing the study noted is that e-mail use varies from one patient to the next. Online communication may work to the advantage of some patient groups more so than others, according to Deloitte Consulting. For instance, chronically ill patients can benefit from ongoing monitoring by their physician. With open communication lines, patients may follow instructions more closely, reducing treatment costs and ensuring quality care.

Essential to Physician Practice?
Only 21 percent of the physicians surveyed believed that the Internet is essential to their practice. In fact, most physicians feel that the Internet has not influenced their practice, and if the Internet were to vanish tomorrow, that would not really have a great impact on them.

Nevertheless, 59 percent of physicians interviewed agreed that electronic communication has the capacity to “radically improve connectivity among patients, providers and payers

(“Physicians and the Internet, Deloitte Research Sept. 3, 2001).'' Table 3 demonstrates what impact the Internet has on physician practices.

Resisting the Urge to Resist
Physicians are not “technophobes,'' according to Deloitte Consulting. Probably the greatest obstacle deterring doctors from making better use of the Internet and electronic communications is an economic one. Procuring online services opens a practice to the following financial risks, says Deloitte:
•        High cost of setting up an information system.
•        Time investment (and cost) of learning to use a new system.
•        Financial/liability risks associated with e-mails and electronic medical records.
•        Financial risk of making an unwise decision when purchasing a new information system.

The thought of spending money on an information system, only to discover it doesn't meet the office's needs, is enough to send physicians running – not walking – away from some of the newest technologies. But, it may not always be best to resist the urge to resist technology, notes Deloitte Consulting. After all, inadequate information systems are one of the biggest factors contributing to an estimated 15 percent to 20 percent of total healthcare spending, according to Deloitte. When physicians are ready to purchase new systems, they must do so wisely.

On the flip side, steadily increasing healthcare costs, partly due to medical errors that could be avoided, are making government regulators question whether it's time to introduce legislation mandating physician use of the electronic medical records, e-prescribing or e-mail communications. Or, government bodies may elect to offer financial incentives, subsidies and reimbursement to physicians who adopt innovative technologies, says Deloitte.

Fifteen years ago, up to 75 percent of physicians were expected to acquire electronic medical record keeping, according to Deloitte. Today, the adoption rate remains as low as 12 percent, with potentially up to 33 percent of physicians interested. The physician adoption rate is taking time. If ever there was a time, it's now.

Use of and Attitudes About E-mail with Patients

 Professional (Not necessarily a daily user, but 75 percent of time online is for professional purposes)Daily (Access the Internet daily for any reason)Online (Have accessed the Internet at some time over the past 12 months)All
Currently using e-mail30 percent25 percent21 percentNA
Activities with patients online    
Routine prescription refills8 percent15 percent13 percentNA
Billing inquiries22 percent21 percent19 percentNA
Scheduling appointments22 percent21 percent24 percentNA
Notification of test results29 percent30 percent29 percentNA
Discussing symptoms or treatment options63 percent65 percent61 percentNA
Reasons for not currently using e-mail with patients    
Not reimbursed for online activity44 percent41 percent44 percent44 percent
Concern about professional liability63 percent62 percent62 percent62 percent
Concern about too many patients sending e-mail65 percent64 percent67 percent66 percent
Prefer face-to-face interaction77 percent81 percent80 percent82 percent

Source: Deloitte Research and Cyber Dialogue Inc.

Use and Attitudes About E-Prescribing

Currently doing e-prescribing7 percent4 percent4 percent
Already using, interested in using, or very interested in future31 percent29 percent25 percent
Reasons for not currently doing e-prescribing   
Hardware outdated26 percent25 percent27 percent
Lack of good services30 percent32 percent32 percent
Unwilling to pay for online services47 percent48 percent50 percent
Not used by all pharmacies/payers55 percent55 percent52 percent
Privacy or security concerns59 percent59 percent61 percent

Source: Deloitte Research and Cyber Dialogue Inc.