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Physician-Patient E-mail Disconnect
Few Physicians Report Using E-mail to Communicate Clinical Issues with Patients, Despite Strong Interest Among Some Patients and Policy Makers
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The American Health Information Community (AHIC), a recently formed federal commission, has identified secure online communication between physicians and patientsespecially those with chronic conditionsas one of a limited number of "breakthrough" information technologies targeted for rapid development. Moreover, 80 percent of online Americans would like to communicate with their doctors via e-mail, according to a March 2005 HarrisInteractive Health Care Poll.
"Despite strong interest among policy makers and the public, most physicians are not rushing to embrace e-mail communication with patients," said Joy M. Grossman, Ph.D., study coauthor and a senior researcher at HSC, a nonpartisan policy research organization funded primarily by the Robert Wood Johnson Foundation.
Based on HSCs nationally representative Community Tracking Study Physician Survey, the studys findings are detailed in a new HSC Data BulletinPhysicians Slow to Adopt Patient E-mailavailable here. The 2000-01 survey contains information on about 12,000 physicians and had a 59 percent response rate, and the 2004-05 survey includes information from more than 6,600 physicians and had a 52 percent response rate.
"While some health plans are testing payment for e-mail consultations, reimbursement remains limited, and thats likely a major barrier to physician adoption," said coauthor Allison B. Liebhaber, an HSC research assistant.
Physician-patient e-mail is most common in larger practices. Physicians in staff/group-model health maintenance organizations (HMOs) and medical school faculty practices reported the highest rates of adoption (47% and 43%, respectively), followed by physicians in group practices of more than 50 physicians (29%). In contrast, only about 20 percent of physicians in practices with nine or fewer physicians reported adopting e-mail use, the study found.
However, growth in e-mail adoption essentially stalled in larger practices between 2000-01 and 2004-05. At the same time, smaller practices with nine or fewer physicians did have statistically significant growth in e-mail use.
"The stagnant growth among large practicestraditionally early IT adopterssuggests e-mail use is not progressing rapidly," Grossman said.
While some patients are eager to communicate with their physicians via e-mail, not all patients have access to e-mail. Rural, low-income, elderly and African-American consumers are among those less likely to have Internet access and, if they have it, to use e-mail, according to the Pew Internet and American Life Project.
Practices with higher proportions of such patients may move more cautiously to offer e-mail consultations because of more limited patient demand and capability. Indeed, physicians in practices in nonmetropolitan areas, practices with high Medicaid and/or Medicare revenue and practices with a high percentage of African-American patients are less likely to report e-mail is used to communicate with patients, according to the HSC study.
The study cautioned that the findings be considered an upper bound on the proportion
of physicians regularly using e-mail in their practices because physicians were
asked about e-mail availability in their practice but not whether they actually
use the technology or the frequency or intensity of use.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.