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Friday, January 7, 2011

E-mail communication with patients

We have been communicating with patients via e-mail for about a year. Since we use GE Centricity's electronic health record system our health system chose to use their platform to offer e-mail, refill requests and online appointment scheduling for patients as well. Our regional clinic piloted the software and found it easy to use. We set up clinical and clerical e-mailboxes within the clinic's system so clinical questions go to a nurse or physician and appointment requests go to clerical. Through the system, patients may e-mail a particular physician if they wish.

Surprisingly, e-mailing with patients is not commonly used, which is similar to our experience with virtual office visits. I think this correlates with phone access. If access is good, then patients are simply not incentivized to change to a new mode of communication. Patient users have a learning curve – albeit not steep – to set up a secure account and learn the software. Patients also seem to have some mistrust at first as to where their message goes. And if we do not respond quickly, there is more mistrust.

E-mail capability does offer convenience and another mode of communication for certain patients. For us, certain groups of patients are our biggest users. Those are patients who are shift-workers or are frequently out of town for work or for education. Other than these groups, we have a hard time getting patients to sign up for usage. When we query patients why they do not subscribe, the most common response is a concern about security. We explain that they must set up a password protected account; however, this seems to make the software seem more complicated than it is.

For those patients who do use e-mail, they generally ask simple questions like if they can increase a medication. They also ask if they need to come in for an appointment or exam, which helps streamline triage. The e-mail communication becomes a permanent part of the patient’s chart, which our attorneys tell us lessens our risk of claims regarding these non-face-to-face interactions. With e-mail communication, only the printed communication happened. Nothing less and nothing more was said or heard.

Everyone worries about the potential for patients who “overuse” e-mail by writing pages and pages of information for the clinician to sift through. We have found this really does not happen very often. Usually, patients' e-mails are very simple and to the point (as I find with most e-mail). For the few patients who have been very verbose and tangential, I have found that it is best to address this right away. I will either e-mail them my specific preferences for how they should communicate via e-mail or address it during their next office visit.

Our physicians have incorporated into the work flow printing an “invitation” and instructions about e-mail to nearly every patient we see as they leave the office. Even with this commitment, less than 20 percent of our patients utilize this service.

–Melissa Gerdes, MD

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About the Author

Melissa Gerdes, MD, is a family physician practicing at Methodist Family Health Center – South Arlington in Arlington, Texas, and former president of the Texas Academy of Family Physicians.

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