New Guidelines Help Physicians Choose Among Online Patient Communication Options

Physician practices find email communication improves productivity and generates income

Responding to growing patient interest in online communication, many physicians are overcoming resistance to electronic communication, but encountering complex choices when it comes to selecting the right tool for their practice, according to a new report prepared for the California HealthCare Foundation (CHCF) by First Consulting Group.

The report, Online Patient-Provider Communication Tools: An Overview, provides a detailed review of electronic communication tools available to physician practices of all sizes; case study summaries on how single, multi-site, and integrated delivery systems use these tools; and vendor lists offering various online communication solutions.

“Physicians use email contact with patients to discuss symptoms and treatment, determine the necessity of office visits, respond to billing inquiries, provide test results, and schedule appointments,” said Keith MacDonald, author of the study. “Contrary to persistent misconceptions, many are finding online communication is manageable, improves productivity, and can even generate revenue.”

Based on a dozen physician practice group interviews, six key issues emerged. These are considered crucial to the selection and use of online patient-provider communication tools:

  • Complexity of infrastructure. Stand-alone products require the least amount of technical savvy and investment. Integrated systems that link to existing electronic medical record (EMR) and practice management systems require more extensive hardware, software, and networking set-up.
  • Degree of integration. While stand-alone products requiring only a PC, software, and an Internet connection enable online communication; integrated systems bring online messaging, patient demographics, and medical records all into one place. Such systems make workflow across the practice more seamless.
  • Message structure. Unstructured messaging is no different than common email. Structured systems, however, use forms and templates to organize the information in a communication for easier response or triage within a practice environment.
  • Cost. Costs range from $50 monthly subscriptions for simple email accounts to advanced EMR products that start at $10,000 per physician workstation.
  • Security. Mechanisms available to assure online security include encryption software that makes it difficult for intercepted messages to be read by unauthorized persons.
  • Potential for reimbursement. Several vendors of secure-messaging systems support mechanisms for payer-based reimbursement. The number of payers considering reimbursement for physician time spent online is growing. In some practices, patients have been willing to pay for the convenience of online communication and at least one vendor enables direct patient billing.Related research has uncovered three primary reasons for physician resistance to online patient communication: fear that high volume will create more work, concerns over inadequate reimbursement for time online, and worry over the risks and liability associated with patient confidentiality. Based on interviews with leaders of physician practices successfully using online communication tools, these concerns were unfounded:
  • The volume of incoming messages from patients was manageable and online communication was easier than other forms of communication.
  • Though financial reimbursement is a crucial factor in the willingness to adopt these tools, several health plans have successfully implemented patient payment systems and the number of payers considering physician reimbursement is growing. The American College of Physicians recommends that Medicare and other payers support reimbursement for online communication.
  • Several organizations offer health systems practical guidelines for implementing secure patient communication. Additionally, final HIPAA guidelines do not require encryption of electronic communication if certain other steps are taken.“Physician practices are adopting online communication tools,” said Sam Karp, CHCF’s director of information technology. “This report’s description of available tools, guidelines for selecting a system, and case study highlights from real world experience should make it easier for other physician practices considering online communication to take the first steps.”

    The report includes detailed descriptions of the characteristics, features, and options for products within the two basic categories of available online tools – stand-alone products and integrated systems – and lists health care organizations using each.

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About the California Health Care Foundation

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.