Patients want online communication with doctors, and more clinicians are listening

As people take on more DIY approaches in their daily lives for travel planning, photo management, and investing, they’re looking for health care touchpoints to do the same — especially, their physicians. In 2011, more doctors are responding to this patient-driven demand, based on data published in the InformationWeek digital health care issue July 25, 2011, titled The Pain of Change.

Most patients would be willing to change physician practices if their doctors don’t offer online access to tools, based on a recent survey from Intuit which Health Populi covered in March 2011 here.

For a long time, physicians were concerned about security in online messaging between their patients and their practices. Today, this is changing: InformationWeek Analytics’ 2011 Healthcare IT Priorities Survey finds that 24% of physicians reports “widespread” use of email to communicate with patients, shown in the bar chart. Privacy, security, liability, and reimbursement are the most-cited reasons for not engaging with physicians via email.

21% of physicians are regularly using a portal or website. Fewer than 1 in 10 doctors report “widespread” use of IM and videoconferencing. However, there is some limited use of social media, wikis, IM and videoconferencing, indicating the clinicians are stepping toes into these emerging platforms for patient communication.

There’s one aspect on which physicians and patients agree: most in each group aren’t keen to connect on Facebook….yet. Still, some providers are experimenting and learning about how to create trust and productive relationships in such online platforms, such as the Mayo Clinic which has a Facebook page and encourages patients to tell their stories on a  YouTube channel.

Health Populi’s Hot Points: Several forces are converging in the health market that will drive physicians to adopt online communication platforms for patient care:

  • Payment models that pay for performance and value, population health management, patient centered medical homes, and accountable care;
  • Meeting meaningful use criteria for EHR HITECH incentives;
  • Consumer demand for online tools, as demonstrated in the Intuit survey.

Many EHR vendors will help physicians to incorporate these platforms into their workflow, as the most popular digital records include patient portals that can enable people to check on their lab results online, tap into personal health records, and schedule appointments.

Furthermore, a few physicians’ professional associations are offering guidance and support for their constituents in adopting online communications with patients. The American College of Physicians has stated that, “e-health activities have the potential to transform the healthcare delivery system” and “advance the patient-centered” medical model. Perhaps the last constraint preventing the most risk-averse physicians will be legal liability. While health information technology promises lots of jobs for workers, there will be ample opportunities for the health care lawyers, as well.

18 Responses to Patients want online communication with doctors, and more clinicians are listening

  1. rc July 27, 2011 at 3:38 am #

    So what next… tweeting and texting whenever wherever??? This is less a question of not being adaptable as much as recognizing limits.

    RC

  2. Marni Myers July 27, 2011 at 4:35 pm #

    It is surprising that more doctor-patient communication doesn’t take place online, given the abundance of health-related information on the internet. Most people I know turn to the internet first when investigating health issues, and many seek out advice from non-medical professionals through online support groups and user forums. There’s also a new online tools called CareCoach.com that can potentially connect doctors and patients virtually by letting users give others in their “care team” access to the health information they put on the site. Patients can record doctors’ visits using a cell phone, upload it to the site, and share the recording and other information with their care team, which could include their doctors. The patient-centered care movement seems to be gaining momentum and I’m hopeful these tools will propel it forward.

  3. Helena July 27, 2011 at 9:30 pm #

    As a nurse and obviously a patient at times, the idea of being able to communicate with my physician online would be fantastic.
    The ability to educate ourselves via the internet has been one of the greatest assets in my lifetime.
    In regards to being able to communicate with my Dr. via internet vs. office visit; Im thinking of the 2-3 times a year I get a sinus infection, in my 48 years the symptoms and routine are ALWAYS the same (call for appt., get “squeezed in”, go out in bad weather, set at the office among coughing, fevered, infected people, see the Dr or NP) pay the $70 office call, (by the way missing work?), get the RX and get well. Why not send my Dr. an online message with the same thing I will say in the office? I believe patients would be more apt to report physical ailments and with more accuracy if they were able to type it in a message, review it and submit to their Doctor. How often have we went to the Dr. and failed to report a symptom that we certainly should have only to feel no recourse without causing too much extra work. And the bulk of the baby boomers still avoid telling their Doctors what they really are experiencing. I have often heard that they don’t feel heard, or they feel like they are a burden, or they are embarrassed, or they think that they are overreacting.
    I am sure that there will be many who will point out a number of problems that can arise but the identification of these problems is how most technology and even patient care improves. Guidelines for hands on physical assessments could start conservatively and change accordingly as data is collected.
    It has not been that long ago that we went to online charting vs paper. What a wonderful advancement that has been. I can only hope that technology continues to be incorporated into healthcare. The information we hear of how poor our healthcare system is in comparison to some other countries that are more advanced should warrant at least an attempt at change. I can’t help but think that there is the potential to have a healthier population and even fewer malpractice lawsuits. Yes, I am optimisitic, and forward thinking. I believe we are either standing still, moving forward or losing ground in every aspect of life.

  4. Pauline Q. Sheehan, MD July 28, 2011 at 12:55 am #

    I’m an Adolescent Medicine physician and as such I have always understood my patient’s need for communicating directly with me. I give my e-mail to all my patients. I take all my patients cell phone numbers. I have a dedicated cell phone just for patients. Surprisingly, they never abuse this privilege.
    Sometimes their messages can be about issues that they wouldn’t dare bringing up in the office, if parents refused leaving the room, as sometimes happens. Most often, they want to be reassured that they are OK, that they did something I know I will be proud of them about, or to give me a progress report on a symptom.
    Teens and young adults don’t do well waiting on hold for a receptionist to answer the phone, who will put them on hold again, to leave me a message that I might or might not get for one or 2 days. ( They detest delaying gratification)

  5. Andrew July 28, 2011 at 2:55 am #

    As a doctor, and certainly as a patient as well, there is so much promise in expanding our ability to communicate. A quick on-line check-in, could obviate the need for taking time out of your day to go to the doctor’s office and wait to be seen.
    The trick, however, lies in the reimbursement. And this is where the crowd goes boooo. As much as I would love to say that I am purely interested in the well-being of my patients, the truth is I have to pay homage to a number of different Gods. And after 8 years of little to no pay, and $500K in school loans (not an exaggeration), getting paid is an issue. So there may well be insurance companies reimbursing for FB communication, but not the ones I know of – at least not yet.
    If you want this to change, and want increased and more relevant communication – the insurance companies who hold the purse strings are the ones to harass.

  6. Felipe July 28, 2011 at 3:12 am #

    so you want your doctor to consult you by email instead of being examinated in his office? Is it really better? Maybe better for those patients who don’t want to pay the visit…
    If your sinus infection has always the same sintoms, so why email your doc? Why dont you just recipe yourself?
    Robots visiting patients, consults by email… No good for your health (just cheaper)

  7. neil July 28, 2011 at 8:16 am #

    As a uk based GP (family doctor) this worries me on different levels. while i can understand the comment about – i always have the same symptoms and get the same treatment – i can give many counter examples of people who have presented with similar symptoms but there has been something slightly different – that ends up being cancer or diabetes or some resistant infection. Having said that I will issue a prescription over the phone or on a online request for patients I know well and there is something to be said for sticking with one doctor who knows you. Certainly here in the UK we do other things while you are with us – health screening, medication reviews, opportunistic checks, health promotion, vaccination etc. that most trips to us arent wasted. (its also free at the point of contact – paid for by taxation – big debate that lets not get into!)

    I said worries on mutliple levels – so another worry is the lack of face to face contact – you might not appreciate it but I get so much information from the way a patient walks into my room, slowly quickly limping breathless with a stick do they look pale jaundiced depressed in pain. One of the things we try to teach medical students is how to recognise a sick kid – just from their look – im not sure an email from their parent will be the same. Verbal communication is much more rapid and sophisicated than email – email is often misjudged in tone. it isnt quick – and people can lie on purpose or by omission – in a spoken conversation I can see your responses – change tack, ask follow ups – never mind the whole art of non verbal communcation – including mirroring, NLP etc.

    how about establishing a relationship? i can usually “get on” with most people i meet within a minute – establish a rapport – bond – trust – enough that they tell me their most intimate fears, secrets worries as a patient it must be easier to do this to someone you know rather than an email that could be hacked? perhaps not. in consultation analysis its called door stepping – people come in and talk about one thing – establish a relationship then as they leave drop the real reason for the consultation – hoping well pick up on it. there is also something called hidden agendas. people repeatedly present with minor trivial symptoms – there is something else going on – either conciously or sub conciously they arent bringing it up – me the doctor has to tease it out of them – it might be depression, anxiety, cancer worry, infidelity, or some other rational or irrational thought/concern.

    face to face doctor patient relationships and communication is an establish science/art – there are numerous textbooks written. e.g. the inner apprentice, the doctor the patient their illness etc. there are numerous experts balint, neighbour to name a couple. email just isnt at this level.

    Ultimately online im going to be more cautious in my practice- order more tests to cover myself – my insurance premiums will be higher to cover the things i miss – you will probably end up paying more for it in the end.

    having said all of that – i think IT has a role – online appointment booking, drug ordering, hd webcams – video is probably the way to go – remote monitoring of illness – i’m into IT just cautious about email consultations.

  8. Dr. Jeff Livingston July 29, 2011 at 6:16 am #

    I love that this topic is explored more and more. I’m a physician at MacArthur OBGYN, a 6-physician practice in Irving, TX. We have 4,700 patients actively using our Kryptiq Patient Portal and secure messaging, which sync with our Sage EMR. Our patients love it, and use the portal to schedule appointments, ask questions, refill prescriptions, and get lab results; all the things mentioned above. It’s substantially improved our office efficiency, and has opened our staff to take more calls from potential new patients. Once most patients learn about our portal and all its capabilities, they can’t wait to start using it. We see new sign ups every month.

    We’ve also ventured into the world of Facebook (more than 1,100 fans) and Twitter (2,386 followers) as a great way to build a social relationship with patients, connect with younger moms and moms-to-be (we see a lot of teenaged mothers), and a way to answer simple medical questions. The biggest rule we follow is to move any too-personal questions or comments from the Facebook wall to secure messaging so patients aren’t violating their own privacy. But general questions are awesome; they let us provide an answer to the whole community. Plus we get to see pictures of all the beautiful babies we’ve delivered as they grow!

    There’s really nothing to fear when you have the right products and some simple guidelines.

  9. Anthony Gold July 31, 2011 at 8:06 pm #

    As more and more payers move toward reimbursing physicians for “online” visits (ala email, virtual office visits, and the like) – primarily through a patient-centered medical home pilot – I suspect the uptake amongst physicians will continue to grow.

    Finding the right balance of communication is key for patient-provider interactions. While Facebook, Google+ (think “patient circle” :-)), and others might serve as useful information forums, the primary essence of the doctor-patient relationship is often 1:1. However, as we move more toward PCMH models, envisioning a “caregiver ecosystem” social circle (PCP, specialists, nurses, patient, other family members) is perhaps not such a stretch.

  10. Cammy August 2, 2011 at 7:45 am #

    The patients which lives far from the cities has the need to online communication with the doctors as they want to communicate with a well experenced doctors

  11. TRacy McManamon August 3, 2011 at 12:40 am #

    A great online communication program is currently underway with UPMC hospitals and physicians. We use it and am able to communicate much more in detail the an office visit. I hop we continue to see migration to this developing technology.

    TBM

  12. Cat Willows April 19, 2012 at 8:40 pm #

    The hours I commute and work, coupled with my current Dr’s office location and hours is not very accessible. I would have to take off from work in order to get appointments, let alone a walk-in. I would have to be really sick to do that. Being able to communicate with the doctor and not thru a nurse or receptionist would be ideal for many situations. I wish there were more offices and doctors like that OB/Gyn, Dr Jeff.

  13. Ed September 3, 2014 at 10:29 am #

    I believe that with the passage of the Affordable Care Act, we have seen improvement in communications between patient and provider. It’s not where we want it to be, but progress has been made.

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