Communication: If You Build It …

One of Christopher Crow’s patients was in Miami, about to leave on a week-long cruise, when his prostatitis flared up again. “He e-mailed me from his hotel room to ask for a prescription,” recalls Crow, whose Web site features secure e-mail messaging. “All he had to do was locate the closest drug store and pick up his medicine the next day. Imagine how difficult it would have been for him, trying to get an appointment with a doctor in a strange city before his ship sailed.”

Crow practices at Family Medical Specialists of Texas (FMST) in Plano, a Dallas suburb. Crow says that the three-physician practice’s Web site, www.fmstexas.com, attracts new patients and helps make the practice far more efficient.

The same goes for the Office of Orthopaedic Medicine and Surgery, a three-physician practice in Washington, D.C. As patients leave after an appointment, they are handed cards with the practice’s Web address (www.dcorthodocs.com) printed on the front and their diagnosis written on the back. “We’ve just upgraded our Web site,” explains Latisha Harrison, the practice’s marketing director. “Now it’s more interactive, and patients can submit forms to us online. We also added an educational guide so now our patients can look up reliable information about their specific condition. Our doctors were really, really adamant about including that feature in the upgrade.”

These physicians are among the early adopters of Web-based technologies for medical practices, although many more are likely to follow their example. In today’s wired world, patients want the same level of service online from their physicians that they already routinely receive from companies selling them books, music, and camping gear.

“Absolutely everyone should have a practice Web site,” says practice management consultant Judy Capko. “It’s a very reasonable investment, and it makes you more visible, not only to your existing patients, but also to people who are searching for a new physician in the area.”

About three-quarters of U.S. adults would like to schedule their doctor visits via the Internet, and they’d appreciate e-mail reminders from their doctors, according to a recent Wall Street Journal/Harris Interactive poll. But only a tiny minority of medical practices offer such services, resulting in a paltry 4 percent of patients using them. Moreover, roughly two-thirds of patients would like to receive their lab results via e-mail, but only 2 percent currently do. It’s becoming increasingly apparent that the practices that invest in these IT offerings will be at an advantage in the healthcare delivery marketplace.

Your billboard on the Web

Some practice Web sites present basic information about the practice, including short biographies of each physician, directions to the office, and forms patients can download and complete at home before arriving for scheduled visits. Other sites boast more sophisticated features, such as Crow’s secure e-mail and gastroenterologist Patricia Raymond’s Web movies.

When patients visit Raymond’s site (www.simplyscreening.com), they find personalized videos available for viewing. Raymond, a solo practitioner in Chesapeake, Va., meets about two-thirds of her patients for the first time when they arrive for procedures. “The videos show me chatting in my living room, answering their most common questions,” explains Raymond. “My patients love them, and the Web site has streamlined getting new patients in for their colonoscopies.”

The specific mix of features your Web site should incorporate depends on the nature of your individual practice. A primary-care practice in which new patients are seeking long-term relationships with a physician should probably use its Internet presence to introduce its physicians and share some personal information about them. A specialty practice such as gastroenterology should focus more on the specific procedures it performs. Most physician practices start out with a basic Web site and then add new features over time as they perceive demand for them.

One way to think about your Web site is to envision it in three developing stages, says Bruce Kleaveland, president of Kleaveland Consulting in Seattle. In the first stage, you offer a basic introduction to your practice. Then, as you expand the site and enter the second stage, you add administrative functions such as giving patients the ability to make appointments, pre-register, and complete downloadable forms. The third stage involves incorporating clinical interactions with patients, such as prescription refill requests and access to secure e-mail communication between physicians and patients.

At this stage, you’ll be handling sensitive patient information, and so you must ensure your site is secure. To do so, employ the services of a company that offers encrypted e-mail messaging. When these companies receive a message from you, they then send e-mail messages to your patients. To access the messages, patients must have user names and passwords. These sites afford the same level of security as do financial services Web sites, such as banks.

At this point, you may also want to set up a process to handle online clinical requests. If your practice has linked an EMR to your Web site, you can automatically call up a patient’s record, which you can view in conjunction with the request. In this case, responding to patients is so easy, physicians can do so with just a few clicks of a mouse. Paper-based practices that agree to field online requests may have to assign a nurse to screen and respond to basic clinical questions such as prescription refills and lab results. The nurse can forward more complex requests to a physician.

Turbo-charged Web sites

The Web site for PeaceHealth Medical Group (PHMG), a 120-physician group in Eugene, Ore., exemplifies the sophisticated features a large practice can offer its patient base. This secure Web site (www.peacehealth.org) is available only to patients who have received a personal password. It gives patients the capability to schedule, reschedule, and cancel appointments; view and download lab results from current and previous visits; and exchange secure e-mail messages with their physicians.

Bill Moshofsky, a PHMG family physician, particularly appreciates his practice’s secure e-mail service. “Whenever I have two minutes between patients, I can just sit down and send off a couple of responses, and I couldn’t place a phone call in such a short time,” he says. “One of the things that’s kind of nice about e-mail is, you just send out the information and you’re done.”

PHMG also hosts a site for the general public. Potential patients can search its Healthwise database for information about their specific symptoms. Visitors can also use the site’s “ask-an-expert” function to send in their healthcare-related questions and view previously posted responses. PHMG has found this community service to be an effective way to attract new patients.

Within the next year, PHMG is expanding its Web site to enable it to send personalized reminders to patients, telling them when it’s time to schedule a physical exam, a mammogram, or similar preventive services. The group is also planning to send personalized electronic newsletters to targeted patients with an interest in specific conditions; these newsletters will be available to nonpatient community members as well as established patients.

In the future, PHMG hopes to link data from their patients’ home monitoring systems directly into their electronic medical records, so that staff can keep a close eye on variables such as blood pressure and glucose levels for the chronically ill. The practice is also considering giving patients Web access to their personal health records. “For example, if a patient wanted to report that they’re cutting pills in half, or taking them every other day, this would give them an avenue for those comments,” says Chuck Broch, PeaceHealth’s systems analyst.

Part of the reason PHMG can do all this is because it participates in a three-state healthcare IT collaboration. But smaller practices can also develop Web sites with similar advanced features using sophisticated software and Web designers who specialize in physician practices.

For example, one physician at FMST with a special interest in information technology supervises the practice’s Web site, while the others chime in with suggestions and comments on future directions. The practice uses software to link its EMR to its secure e-mail service, so physicians can respond to patient e-mail requests quickly and safely.

The Office of Orthopaedic Medicine and Surgery called on iHealthSpot to create its new Web site. That company grew out of a partnership between a patient with a broken leg and a surgeon with an interest in Web technology. Today, iHealthSpot specializes in Web site design for small physician practices, also offering secure e-mail hosting, patient education materials, search engine optimization, and nightly backups. Its most complete package will set you back roughly $3,000.

Clearly, patients value being able to easily access their physicians and take care of personal healthcare tasks via the Internet. Physicians also enjoy the enhanced efficiency highly developed practice Web sites can bring. But it’s difficult to quantify exactly how much time a well-run, multifunctional Web site can save the average practice. Simply posting your address, map, and directions on your site must save phone time for front-office staff - but exactly how much time?

FMST can give you an idea: Named Practice of the Year in 2006 by Physicians Practice, this group is on the technological cutting edge, with a seamlessly integrated EMR and secure e-mail messaging. “The national average for staff in a primary-care practice is just under five employees per physician,” says Crow. “We need less than 2.5 employees per physician.”

You can do the math.

When Crow arrives at work in the morning, lab results from yesterday’s patients are in their respective electronic charts. “I review them and then click a few times to e-mail those patients that their results are waiting on our Web site. The work flow takes seconds,” he says. “Compared to the old system with paper charts and lab reports, where you handed the chart to a nurse who sent the information to the patient … you are probably saving $5 or $6 each time you send out lab results.”

Elaine Zablocki is a writer who has focused on healthcare issues for more than 20 years. She is the editor of Great Boards newsletter and Physician Office Laboratory News, and she contributes to many other healthcare publications. She can be reached via editor@physicianspractice.com.

This article originally appeared in the May 2007 issue of Physicians Practice.