April 2004
Many proponents of telemedicine believe that the “office visit” of the future will likely involve patient and physician sitting in front of cameras attached to computers, the doctor examining a rash or monitoring a symptom diary while the two converse verbally or electronically. An April 2004 article in the New England Journal of Medicine paints a picture of this future.
Tom Delbanco, M.D., and Daniel Z. Sands, M.D., M.P.H. write that this new dynamic will lead patients and health care professionals to work together to ensure a transparent system that enables them to share knowledge, responsibility and decision-making more equally. According to Delbanco, "Patients will soon have full and continuous access to all notes in their personal, electronic medical record offering them the opportunity to suggest amendments, to disagree with their doctors’ views, and to point out and correct errors. This should enhance patient safety and promote both patient responsibility and shared decision-making."
What about security? The growth of electronic communication options presents opportunities and challenges. E-mail and secure web-based portals offer patients better access both to their doctors and to applications where they can review their medications and correct errors, request prescription refills, make appointments, retrieve laboratory results and view radiology images. One currently-functioning example is the PatientSite secure portal.
Many surveys find physicians are less enthusiastic about electronic communication than their patients. Only about a quarter of practicing physicians reporting they had conducted e-mail conversations with patients – and fewer encourage the practice as a matter of course.
Health care providers who have used e-mail on a regular basis find that such interactions can offset costs incurred by telephone calls, missed or avoidable appointments, medication errors and requests for prescriptions. “For doctors, at a time of disquiet, fatigue and bombardment by paper and electronic ‘noise,’ even if e-mail improves the quality of communications with patients it threatens to break the camel’s back,” Delbanco and Sands write.
Health care providers are also concerned about the lack of compensation for time spent handling e-mail interactions. Surveys found two-thirds of physicians would use e-mail if they were paid for the time involved, and the authors note than insurers and health plans – at the urging of the American Medical Association and the American College of Physicians – are looking for payment methods. Pament might be by the message, the episode of illness, or through an annual per-patient or global practice fee.
Getting physicians to use email is only one piece of the solution. Equally important is a joint effort between patients and health care professionals to create and evaluate new portals, record systems and practice guidelines that delineate shared expectations. The authors recommend that the medical community learn from online merchants, auctioneers and bankers who have created systems that can make individuals feel valued, while handling vast numbers of interactions without free text e-mail exchanges.
"E-mail gives doctors and patients more time to think. Doctors and patients move closer together and trust grows strikingly. Interchange becomes more personal and office visits seem more efficient and less emotionally charged," according to the authors.
"And with time ‘off-line’ to reflect and learn, patients appear better able to grasp information that is central to their care. Indeed, as one of our patients told us: 'Exchanges by e-mail are the next best thing to a house call.'"
Reference: Tom Delbanco, M.D., and Daniel Z. Sands, M.D., M.P.H., New England Journal of Medicine, April 22, 2004
Last updated 11/29/05
