E-mailing With Patients

How many times a day do you get a message from a patient with a basic question or request, and you return the call only to get the answering machine - and the phone tag begins?

Imagine being able to respond to the patient once, providing a written response with answers, a lab result, or a prescription refill. That can be just one of the many bonuses of using secure e-mail messaging to communicate with patients.

"The benefits are huge," says consultant Judy Capko. For starters, online messaging eliminates phone tag. It can save time, expedite responses, and provide a paper trail, she adds.

So why hasn't it caught on with practices? The concerns about e-mailing patients are just as huge: According to the 2010 Physicians Practice Technology Survey, only about 38 percent of respondents say they e-mail with patients. Nearly 60 percent cited privacy concerns when asked why they don't use e-mail. About a third said they didn't have time, and a third said they can't get reimbursed.

However, there are solutions to many of these barriers, and many practices are finding that these woes are far outweighed by the benefits. Here's a look at how you can make e-mail work.

The basics

You have a couple of options for online communication with patients, one being traditional unencrypted e-mail messages such as those sent through Yahoo! or Outlook. These platforms lack the necessary security for corresponding about sensitive health and personal information, but that doesn't mean it's a deal breaker. As long as the patients agree to communicate in this way and understand the security risks, then you have the green light, says Jason Mitchell, assistant director of the Center for Health Information Technology at the American Academy of Family Physicians and a former family physician. Just make sure you explicitly explain the nature of e-mailing in the HIPAA agreement patients sign.

And regular e-mail is a good place to start, Mitchell says, although you will be limited in the extent of communication and the depth of health information you can discuss.

A more secure option is through a patient portal, which is a fancy term for a secure and interactive Web site. Patient portals let practices use secure messaging, as well as more advanced interactions such as scheduling or refill requests.

Just as bank customers can log on to view their account information and send and receive messages to their bank, so too are patients able to connect online with their physicians. Rather than receive a lengthy and potentially sensitive message in their inbox, patients receive a note requesting they log in to retrieve test results or a response from their physician.

The benefits

E-mailing with patients requires a change in your work flow, an investment in new technology, and the development of robust policies. So, you may be wondering, why bother? One reason is that patients are demanding it.

"Marketing and listening to your customer should be good enough reasons," says MGMA consultant Rosemarie Nelson. Patients increasingly want the added convenience of connecting online.

Plus, they often would like to see in writing their physicians' explanations or test results. That can translate into better patient care. E-mail messages can allow you to provide more detailed and accurate information to patients, and patients can be more involved in their own care.

A major benefit for your practice is the documentation. Rather than having to transcribe the phone correspondence, the e-mail message can be directly imported into your EHR. And cutting out that phone tag can mean increased efficiency.

Worried that making e-mail available will open the flood gates and you'll be inundated with messages? That hasn't been the case, Mitchell says. Many studies have shown that patients don't abuse e-mail. A 2007 Journal of Pediatrics study of families who e-mailed their doctors found that doctors received about one e-mail message a day, and responded 57 percent faster than by phone.

E-mail may also save you and your patient from some office visits. "There are plenty of established office visits that we don’t need," Nelson says. Through the patient portal, practices can extend beyond the basic message and conduct an online visit. A practice can set up an e-consult template where the patient fills out detailed information and pays a fee. The physician then responds directly.

"It leaves your schedule open for the patient who really needs to be seen," Nelson says.

Not convinced yet? Consider the experience of Summit Medical Associates PC in Hermitage, Tenn. For about two years, patients have been logging into the portal to ask questions, receive health information, request prescription refills, and more. Summit has seen a reduction in phone calls and paperwork, and patients are clearer on their health information, says Tammy Sawyer, Summit's information systems manager.

"It is a win-win for the patient and the practice," says Sawyer. "It's intimidating at first because it is different, but the pros absolutely outweigh the cons."

Getting paid

Many physicians shy away from e-mail because they are concerned they won't get paid for their time. However, e-mail communication mirrors two activities you're familiar with: returning phone calls and the office visit, Mitchell notes. You already aren’t reimbursed for most phone calls, so if your e-mail message is the same quick, straight-forward interaction, it's not something you should bill for, he says.

The online correspondence can also reflect some office visits. A growing number of insurance companies are beginning to cover online consults, as long as you submit the right CPT code, 99444, and it's properly documented. These so-called e-visits are far more structured and involve some medical decision making, so you should bill for it.

Many practices also rely on self-pay, Nelson says, such as charging that $35 fee for the e-consult. Another option is assessing an annual technology fee to cover online communications. Patients are often willing to pay, as it saves them time and expense of coming into the office.

For many practices, including Summit, the ease of e-mail is more of a money saver. At the Arkansas Otolaryngology Center in Little Rock, Ark., the practice recently implemented a system for secure messaging, but isn't getting paid yet. "Right now, we have looked at this as not a substitute for an appointment, but as a way to [handle] the normal phone conversations," says physician John Dickins, adding he hopes reimbursement follows as more practices and healthcare organizations adopt online communications.

In the meantime, he says, "There's two ways to make dollars. One is someone pays you, the other is you don't spend it. If my nurse is more efficient and can actually do other things, that's a significant amount of money we aren't expending."

Getting started

Here are a few quick points to keep in mind before you tackle e-mail:

• Consult with your Web site provider to see what your messaging options are. If they come up short, work with your EHR vendor, which may have an option that connects directly to the system. Or search online or through colleagues for a patient portal vendor.

• Develop an internal policy. Make sure staff members are clear on their responsibilities and trained on the new work flow. Consider guidelines for message turn-around time.

• Include a clause in your notice of patient privacy and make sure patients understand the risks and limitations of e-mail. Add that information, plus your practice's e-mail policies, to your Web site.

Sara Michael is senior editor at Physicians Practice. She can be reached at sara.michael@ubm.com.

This article originally appeared in the January 2011 issue of Physicians Practice.