Patient–Provider Use of Electronic Communication
The provision of clinical consultation services by e-mail has been controversial. Nevertheless, charging the consumer directly for a health care consultation by web/e-mail has been part of e-health almost from the beginning . Governmental organizations, regulators, and organized health care became alarmed at the misuse of the system by unknown practitioners diagnosing and prescribing treatments for unknown patients. There were many examples of abuse of the system and of the system getting out in front of regulators and legislators. Since those early days in the 1990s, health care oversight agencies have begun to respond . At the same time, consumer demand has attracted the attention of even the most conservative medical organizations.
E-mail has the potential to profoundly affect the communication between providers and patients, but as yet, use of e-mail in clinical care has been sporadic. However, patients also want access to e-mail consultations with their personal providers. Ninety per cent of adults who use the Internet want to exchange e-mails with their.
The four activities most desired by patients are:
(1) asking questions when a visit is not necessary,
(2) making appointments,
(3) renewing prescriptions, And
(4) receiving medical test results. In addition, e-mail health-related reminders and a follow-up summary of office visits are considered highly desirable by patients.
Over 50% of patients in one study indicated that the availability of online
communication with a physician or health plan would influence their provider or plan selection process.
However, only 9% of people surveyed have reported exchanging e-mails with their providers. The percentage of physicians using e-mail to communicate directly with patients in one survey averaged 26% with another 13% planning to in the next 18 months. Physicians who do use e-mail with patients have reported using it for the following reasons: discuss symptoms and treatment (39%), determine whether a visit is needed (32%), address billing inquiries (31%), provide test results (21%), schedule appointments (17%), and authorize routine prescription refills (13%). A recent study conducted a content analysis of the e-mail exchanges between parents and pediatricians. The most common result of an exchange was a prescription or OTC recommendation (42%). Only 11% resulted in an appointment for an office visit, and 5% resulted in a subspecialty referral. While studies examining consumer desire for e-mail consultations with pharmacists are lacking, some research suggests that e-mail consultations may be attractive to pharmacy patrons. A recent study of pharmacy patient preferences indicated that waiting to talk to the pharmacist face to face was undesirable for a number of reasons, including that the patient felt too ill or tired after their physician visit, and the lack of privacy in the pharmacy discouraged communication with the pharmacist.
A survey by WebMD of community and chain pharmacists reported that 22% of retail pharmacists communicate with other professionals by e-mail and 10% with their patients/customers.
While the potential currently exists for a variety of health care professionals to communicate with patients and monitor their response to therapy electronically, this is rarely seen in practice.
The factors commonly cited that limit e-mail use with patients are:
(1) providers prefer face-to-face communication,
(2) there is a lack of reimbursement for e-mail communication,
(3) privacy/security concerns, and
(4) the potential increase in workload associated with using e-mail . Limits are also presented by what has come to be known as the “digital divide,” meaning that not all patients have access to computers and e-mail capabilities.