E-Mail Could Replace Some Patient Visits


ORLANDO, FLA. — Don't take this personally, but … "Patients really don't want to see you," John Bachman, M.D., said at the annual meeting of the American Academy of Family Physicians.

That's one reason why e-mail communication between physicians and patients can be successfully incorporated into a medical practice, he said.

The standard process for an office visit is expensive, inefficient, and inconvenient, but e-mail can change all that, said Dr. Bachman, professor of primary care at the Mayo Clinic, Rochester, Minn.

In a recent survey, 50% of patients said they would like to communicate with their doctor online, and half said they would make the availability of e-mail communication a factor in choosing a doctor. About 25% of doctors said they had communicated with patients via e-mail, and about two-thirds said they would use e-mail if they were paid for the service.

E-mail provides an opportunity to improve patient satisfaction—and it is reimbursable in some instances. Furthermore, most patients are willing to pay out of pocket for the convenience, Dr. Bachman said. At one major practice, about 16,000 patients pay $60 per year for electronic access to their physician via MyChart (Epic Systems Corp.). More than 90% of the 150 physicians in the practice say they are satisfied with the system, he added.

Additionally, major insurers such as Aetna, BlueCross BlueShield, and UnitedHealthcare provide reimbursement or are testing reimbursement for e-mail communications by doctors. Reimbursement is generally in the $20-$25 range, and in some cases patients have a $5 copay for the service, he said, adding that the ICD-9 code for e-mail consultations is 0074T.

E-mail communication works best with established patients with whom you already have a good relationship; those who start practicing medicine via e-mail with patients they don't know could be setting themselves up for malpractice suits, he said.

It could be used prior to patient visits for history taking and for appointment reminders, or after a visit for reporting lab results. Immunization records could easily be supplied to patients enrolling in school.

The approach reduces phone calls and workload for staff. A physician could easily process 12 e-mails in an hour, Dr. Bachman said, noting that in his experience, 85% of e-mails can be handled by staff, and e-mail communication reduces follow-up office visits by 50%, and all visits by 20%.

Establishing effective physician-patient e-mail communications requires a secure server. A platform with a Web site that allows patients to provide medical information, download medical information, schedule visits, and pay bills is ideal.