While patients and health organizations favor the use of electronic communications in clinical care, primary care physicians are not likely to adopt it unless different payment models emerge, according to a study from Weill Cornell Medical College.
The detailed report of six diverse medical practices that routinely use electronic communication for clinical purposes appears in the August issue of Health Affairs, and finds that medical group leaders consider it to be efficient and effective, enabling doctors to e-mail test results to patients or manage clinical conditions without requiring a time-consuming and costly visit. But doctors are unwilling to adopt it until patient workloads are reduced or they are paid for the time they spend phoning and emailing patients, both during and after office hours.
According to data, by 2008, less than 7 percent of physicians regularly communicated with their patients electronically.
Researchers investigated how different practices used e-communications, how successful they were, and what barriers they faced. They interviewed leaders of 21 medical groups, as well as the healthcare staff, including physicians, in six groups that use electronic communications extensively, but varied in their approach. Five of the six medical groups were large — four had more than 500 physicians and one had 115 physicians. The sixth had 15 physicians within a large academic medical center. None were affiliated with Weill Cornell.
Key findings from the study include the following:
- Medical leaders said they started electronic communication programs to improve access to care and communication with their patients.
- All six practices used the program to communicate test results, to allow patients to request medication refills, appointments and to ask questions of their doctors.
- Three practices used nurses, medical assistants or case managers to triage messages from patients; in the other three practices, patients could email nurses for refills or the front desk for appointments, but they could also email their physician directly.
- The volume of emails that reached physicians in the six programs varied from five to 50 daily.
- Only one clinic charged patients for “e-visits” — email that involved clinical decision-making. This group negotiated reimbursement for e-visits with private insurers and patients paid a copayment. Another clinic imposed a $60 annual fee for unlimited electronic communication, but later dropped the charge because competitors provided the service for free.
- Two medical groups added “desktop medicine time” to their physicianss schedules, while another allowed providers to decide how many patients they would see each day, thus providing time for electronic communication.
Leaders and frontline providers also said the system was efficient, safe, and helped them provide high-quality care. Physicians also said it was an efficient form of communication for them.
Researchers found the primary disadvantage to using electronic communication is that it creates more work for providers. While electronic communications does seem to reduce office visits for individual patients, many physicians do not have a decreased overall workload — their clinics send them additional patients to see. She says these issues can be addressed by team-based care that manages electronic communications and workload, or by compensating physicians for electronic communication in ways other than traditional fee-for-service, which does not yet include payment for time spent on emails, researchers say.
Source: Robert Wood Johnson Foundation (RWJF) , August 2013
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