The Doctor Is in — and Online

New pilot programs boost doctor-patient e-mailing

By Kate Pickert Monday, Aug. 09, 2010
    • Illustration by Oliver Munday for TIME

    Have you ever felt slightly under the weather, called your doctor for advice and been asked to drag yourself to her office — only to be told to rest up and drink lots of fluids? Or, worse, have you ever spent a day playing phone tag so you could get the results of an important diagnostic test?

    Chances are these inconveniences could have been avoided if your doctor used a simple, ubiquitous tool: e-mail. A study published in the July issue of Health Affairs indicates that patients who use e-mail to communicate with their doctors not only save time and money but also have healthier outcomes. The authors reviewed more than 500,000 patient-doctor e-mails sent within the Kaiser Permanente network and found that people with hypertension or diabetes (or both) who e-mailed their doctors managed their blood pressure and blood sugar better than non-e-mailers.

    Given this news and given that millions of Americans have had e-mail accounts for more than a decade, why is it that only a small percentage of physicians report that they use the tool with patients? One reason is that primary-care providers, the doctors most likely to be able to coordinate care via e-mail, generally get paid $60 to $100 per office visit and $0 per e-mail. This kind of electronic communication is not recognized as a billable activity by Medicare, Medicaid or most private insurers.

    Kaiser is a special case in that the people it insures receive care at Kaiser-owned facilities where the doctors are essentially paid per patient, not per procedure. Its physicians "don't get paid by generating more visits, so they find a more efficient way," says study co-author Terhilda Garrido. "It's in their best interest to use e-mail."

    The new Patient Protection and Affordable Care Act could help spread the use of e-mail, since the law is funding pilot projects similar to the Kaiser system. Dr. Fred Ralston, president of the American College of Physicians and an internist in private practice in Tennessee, is one of thousands of doctors across the country experimenting with such a model. The extra funding — which, in Ralston's case, comes from BlueCross BlueShield of Tennessee — could allow more primary-care doctors to fully embrace e-mail.

    "It's a wonderful thing," he says. "You can spend probably 30 seconds and give patients commonsense advice."

    Most doctors who e-mail don't use Gmail or Outlook. To comply with federal privacy laws, they contract with software vendors to set up secure independent websites. Some private insurers will reimburse for secure, third-party electronic communication but won't do so for standard e-mail. Cigna, for instance, pays doctors about $25 for an "eVisit," in which patients, rather than writing free-form messages, fill out discrete Web-page fields.

    Dr. Richard Baron, a Philadelphia internist, takes a different approach. Patients can log on to his practice's secure website and write as much as they like. "When people want to interact with their doctor, they want to do it in a conversational mode," he says. Thanks, Doc. :)