Email has become one of the most widespread forms of communication, with its streamlined interactions benefiting both businesses and individuals. With the advent of secure patient web portals and the faith that online access has the potential to improve care, the medical industry is slowly catching up.
And while it may take time before it's known what impact email exchanges might have on patients and their care, a new study from Beth Israel Deaconess Medical Center (BIDMC) offers some early insights into the effects on doctors, suggesting that reimbursement models and physician workflow may need to adjust to accommodate message management.
The results were published online in October in Health Affairs.
"BIDMC was one of the first hospitals in the country to create a patient web portal providing a secure platform for patients to view parts of their medical record and send emails to their clinicians," says lead author, Bradley Crotty, MD, Division of Clinical Informatics. "The portal became available in 2000, so we were able to take a 10-year look at the data and examine the email traffic resulting from this new use of technology."
From 2000-2010, nearly 50,000 patients enrolled in BIDMC's patient portal, representing about 23 percent of all patients cared for in the system.
"During the study period we saw a nearly threefold increase in email traffic between patients and doctors," says Crotty. But, he says the driver of the increase appeared not to be individual patients sending more messages, but rather more patients signing on to the portal.
"We saw that over time as patients moved through an early adopter phase and settled in to the idea of communicating this way, the overall number of messages per patient didn't continue to rise, but plateaued over time. However, as more patients enrolled in the portal, physicians' inboxes increased."
The bottom line is that overall, patients didn't message more over time. Still, Crotty found that some doctors exchanged more email than others. Primary care doctors, for example, represented only 40 percent of doctors in the system, but received 85 percent of the email traffic.
"Surveys have shown that patients desire the ability to communicate with their doctors using email, and on face value it seems to be a good idea," says Crotty. "There's a lot of efficiency in being able to send an email and get a response. That type of exchange has the potential to be more respectful of patient's time and possibly the doctor's time too."
Additionally, phase two of the federal program, known as "meaningful use," which is administered by the Office of the National Coordinator for Health Information Technology, includes efforts to improve usage of the patient portals. To receive incentives in phase two of meaningful use, medical providers must meet a threshold of exchanging at least one secure email with five percent of patients within a 90-day window.
"There's been some question about whether that's a high threshold," said Crotty. "But in looking at the data, it appears to be reasonable. At BIDMC, 8.4 percent of the health system's patients sent at least one message to their physician in 2010."
Meaningful use literature cites research demonstrating, among other things, that secure messaging can help improve patient adherence to treatment plans, which, in turn, can reduce hospital readmission rates.
"There's good reason to believe that technology can help improve care," says Bruce Landon, MD, Professor in the BIDMC Division of General Medicine and Primary Care and the Department of Health Care Policy at Harvard Medical School. "Secure messaging can help maintain the doctor/patient relationship outside of the office, aid in patients getting clarity about medical concerns and possibly even play a role in lowering healthcare costs."
But, Crotty, Landon and colleagues ask, in a fee-for-service model of care, how do doctors get reimbursed for email time? And as the healthcare industry moves toward managed care models, where email exchanges will likely become an increasingly more important tool, how can doctors better incorporate email exchanges into the flow of their already busy work days?
"We're convinced that technology has an important place in healthcare delivery and that email between clinicians and patients will remain an essential element even as care models move forward," says Crotty. "But it may require some policy changes and will most certainly involve adjusting the doctor's day, building in time going forward to meet patient demand for email communication."
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide.
BIDMC is in the community with Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Plymouth, Anna Jaques Hospital, Cambridge Health Alliance, Lawrence General Hospital, Signature Healthcare, Beth Israel Deaconess HealthCare, Community Care Alliance, and Atrius Health. BIDMC is also clinically affiliated with the Joslin Diabetes Center and Hebrew Senior Life and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit http://www.bidmc.org
Kelly Lawman | Eurek Alert!
Product placement: Only brands placed very prominently benefit from 3D technology
07.07.2016 | Alpen-Adria-Universität Klagenfurt
NASA Goddard network maintains communications from space to ground
02.03.2016 | NASA/Goddard Space Flight Center
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy