Only about one in 10 patients communicates with their physician online -- a number that has barely budged in several years. But a new Health Affairs study shows that patients who email their doctors are likely to receive higher-quality care and have better outcomes than those who don't. With any luck, this study and future studies like it will help convince more doctors that it makes clinical -- if not economic -- sense to e-mail with their patients. And healthcare reform might supply the economic justification, as well.
Kaiser Permanente, the big group-model HMO, rolled out secure online messaging to its 9 million members from 2004 to 2010. The Health Affairs study, conducted in Kaiser's southern California division, analyzed 630,000 e-mail messages between patients and doctors from March 2006 to December 2008.
The researchers used two approaches to measure the effect of e-mail on the quality of care for 35,000 patients who had hypertension, diabetes, or both conditions. First, after accounting for certain variables, they compared how well e-mail users and non-users did on standardized measures for hypertension and diabetes care, such as the completion of recommended tests, blood pressure control, and cholesterol control. E-mail users improved on these measures between 4 and 11 percent more than non-users did during the study period.
The second approach was to pair e-mail users and non-users according to their individual characteristics. This matched-control analysis also yielded positive results, with the e-mail users achieving gains on key performance measures of 2.4 to 6.5 percent, compared with the matched controls.
While there are certain variables that can't be accounted for, such as the self-selection of e-mail users, the study appears to vindicate those who say that non-visit care can help patients manage their care better. Of course, Kaiser Permanente is far more advanced than the typical physician practice when it comes to making sure that patients receive recommended services. Still, this study plainly contradicts the belief of many physicians that treating patients over the Internet, even for minor issues, is poor quality care that can open them to increased malpractice liability.
Unfortunately, it doesn't address the real reason why less than a third of physicians invite their patients to email them. The main issue is economic: Although an increasing number of health plans are reimbursing physicians for online consultations, they typically pay less for a "virtual" visit than one to the office. So, especially for beleaguered primary-care physicians, the idea of spending some of their precious time online with patients seems like a giveaway.
Help may be on the way from both the government's health IT incentive program and the Affordable Care Act, aka healthcare reform. To show "meaningful use" and qualify for the government electronic healthcare record subsidies, physicians have to give patients timely access to and electronic copies of their personal health information. That may start opening up online communications between doctors and patients.
The reform legislation encourages several approaches to reforming the system of physician reimbursement. When physicians are being paid to keep people healthy or to keep their chronic conditions under control, rather than performing more services for them, I suspect they will suddenly develop an acute interest in e-mailing with their patients. Kaiser Permanente, of course, is already at financial risk for the health of its patients, so it strongly encourages its physicians to use its secure messaging system.
Like everything else in our healthcare system, the way that doctors and patients communicate won't change until the financial incentives do.
Image supplied courtesy of southerntabitha at Flickr. Related: