E-mail can be a useful tool to improve patient outreach, access tocare

Sure, e-mailing your doctor about that tickle in your throat or the recurring rash on your arm sounds like a great deal-no appointment needed and no copayment. But what if there is a price tag, albeit small, to e-mail your doctor about non-urgent medical problems? Would you still choose this communication vehicle?

Although reimbursement for patient-doctor communication via e-mail as well as security, liability and confidentiality issues are concerns, these potential problems have not stopped pilot programs.

The research also shows that those who communicated with their doctors online were 50% less likely to miss work because of illness, and their claims cost were at least $3 less per member per month compared with members not using the program. In addition, both a majority of members and physicians expressed satisfaction.

AWAITING SECOND PILOT RESULTS

After the success of its first pilot for PPO members, San Francisco-based Blue Shield of California initiated a three-year pilot program at the end of 2003, involving 1,800 physicians affiliated with the health plan and 17,000 members systemwide, a larger and more diverse population. This second study will examine costs, utilization and satisfaction, and results are expected during the third quarter of 2006.

Blue Shield is reimbursing physicians for Web visits, which Sejal Hingrajia, project manager at Blue Shield, says opens the door to online communication at the plan. PPO members' doctors, for example, receive $25 from Blue Shield minus the copayment for Web visits.

Hingrajia says the challenges of introducing a new technology are to be expected. "There is always a learning curve," she says, "and it takes time to get medical groups on board, train physicians and make it available to members."

Mark Schafer, MD, medical director for Bristol Park Medical Group, a primary care physician practice with 11 locations in Orange County, Calif., says he receives a few e-mails a day from patients, requesting lab results, asking for prescriptions and now for soliciting advice for minor medical problems. He finds that questions from his patients prompted by RelayHealth result in important details about their medical problems while only about 10% lead to an office visit. Bristol Park has 55 doctors participating in Web visits.

"Online communication has improved patient satisfaction," he says, "and it's faster to write an e-mail than communicate over the phone. As an internist, I can spend more time with serious cases by handling the minor ones by e-mail."

Dr. Schafer says he checks his e-mail throughout the day and responds within 24 hours; however, he notes the importance of letting patients know that response time is not as quick as it is by phone. The Orange County medical director is waiting for the ability to integrate the online visits with an electronic medical record (EMR), making it possible to move seamlessly between both.

RelayHealth's secure Web site prompts patients to describe their symptoms and what kind of help they need with a branched logic approach. Physicians determine how quickly they should turn around an e-mail, but the time frame usually falls within three business days.