Study: Less than 7% of doctors email patients

Posted on October 28, 2010 by Steve Fox and Vadim Schick

According to a new study by the Center for Studying Health System Change, less than 7% of U.S. physicians communicate with their patients via e-mail. According to the Wall Street Journal, most physicians did not have access to electronic health records or other health information technology allowing secure communication with patients online. Yet even among those physicians with access to such technology, only 19.5% reported communicating with patients via email regularly.

Via the Journal:

This survey didn’t ask non-emailing physicians why they weren’t trading LOLs and emoticons with their patients, but the CSHSC brief has a host of previously cited reasons: “lack of reimbursement, the potential for increased workload, maintaining data privacy and security, avoiding increased medical liability and the uncertain impact on care quality.” (Given that list, it’s hard to figure out why any physician would choose to email patients.)

Doctors working in practices the have already converted to electronic medical records were more likely to communicate with patients via email. So were physicians in HMOs or academic centers, compared to those in solo or two-doctor practices.

 

 Given the reimbursement issue, it’s not surprising that physicians on a fixed salary were more likely to communicate with patients than those with other compensation arrangements. (Aetna and Cigna are among the insurers reimbursing providers for communicating with patients via secure messaging.) Other options for compensation include a set per-patient fee paid to physicians for agreeing to coordinate care using email and other means or an annual fee paid directly by patients for email access privileges, the brief says.

Policy types “might more systematically explore whether email or other secure electronic communication with patients can deliver on its promise to enhance communication, increase patient engagement and satisfaction, improve patient outcomes and quality of care and boost efficiency,” the brief says. If email does all (or some) of that, “expanding incentives to encourage email communication between physicians and patients might be a worthwhile investment.”

"You've Got Mail - But Not From Your Doctor," Wall Street Journal (October 7, 2010).

 
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Study finds big increases in physicans' online communications with patients

Posted on February 16, 2010 by Steve Fox and Vadim Schick

According to American Medical News (AMN), a new report by Manhattan Research states that online communications by physicians have increased by 14% since 2006.  The survey of 1900 physicians found that 39% of physicians use online communication tools such as email, secure messaging, or instant messaging.

Dermatologists lead all other surveyed practices in the volume of online communications, which, according to Girish Munavalli, MD, assistant professor of dermatology at Johns Hopkins University School of Medicine, can be attributed to "a lot of triage calls and calls for clarification of instructions" which come from dermatologists' large patient volumes. "This is perfect for short e-mail communication and reminders," added Dr. Munavalli.

Dermatologists are followed by oncologists, neurologists, endocrinologists, infectious disease specialists, and primary care physicians.

Of course, certain obstacles remain.  Some doctors abstain from using such technology because of liability worries, while many patients prefer in-person meetings because of concerns regarding privacy of their health information.  Still, the report suggests that this increase may be due to the growing comfort level and acceptance of online communication between physicians and patients.  And it may even indicate a larger trend of greater familiarity and use of other health-related technologies, such as EMRs and personal health records.

Graphic via AMN.  Source: "Physicians in 2012: The Outlook on Health Information Technology," Manhattan Research, January.

"Online contact growing between physicians, patients," American Medical News (February 15, 2010).

 

 
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Risk Prevention/Management Advice to Hospitals Regarding Document-Sharing Technology

Posted on April 1, 2009 by Steve Fox and Vadim Schick

Hospitals, multi-hospital systems, and integrated healthcare delivery systems are increasingly utilizing data-sharing technology to communicate with, and share documents among, their officers and directors. 

For example, some healthcare business enterprises use online services to upload documents to a “secure” Internet web site for Board members’ review prior to Board meetings, in lieu of sending out such documents via e-mail or in paper form. Healthcare business enterprises using such services need to be aware of many potential security and privacy risks inherent in transmitting, uploading and storing sensitive, confidential or even proprietary information via the Internet.

 

 

Communications to a hospital Board may include:

  • Confidential information regarding the hospital’s operations or personnel;
  • Data on non-public commercial and financial affairs of the hospital;
  • Legally privileged information regarding law suits on behalf of or against the hospital; and
  • Confidential and privileged peer review materials, including protected health information (PHI, as defined under HIPAA) of the hospital’s patients.

Prior to acquiring or using such data-sharing technology, healthcare business enterprises should make sure that the software is secure and that both the enterprise and the service provider use appropriate physical and technical security safeguards to protect personal and otherwise protected information. There is no one fail-safe approach to implementation and operation of data-sharing technology, and such technology should be customized to fit the enterprise’s needs and requirements. However, at minimum, preliminary precautions should include:

  • Knowing exactly what information is being distributed, via what channels (e.g., whether it is contained on a laptop, another portable device or on the network);
  • Avoiding access, storage, sharing, or use (including downloading, printing, or emailing) of information from or via unsecured home office computers or other mobile devices;
  • As much as possible, limiting the unencrypted sensitive data being transmitted;
  • Avoiding use of actual personal or confidential data in testing of the software;
  • Implementing access control checks, including restricting access to essential personnel only;
  • Using intrusion detection technology or procedures to quickly detect any unauthorized access; and
  • Training and educating all relevant personnel and all persons with access to such information regarding the enterprise’s data privacy protection policies and procedures.

In order to protect your healthcare business enterprise, your Legal and IT teams should negotiate an agreement with the service provider which, at minimum, includes the following provisions:

  • A warranty from the service provider that their product is safe, secure, and complies with all applicable privacy and security standards; 
  • A requirement for the software provider to comply with your institutional privacy and security policies, as well as all applicable laws and regulations;
  • An explicit prohibition for the service provider to use, communicate, divulge, exploit, duplicate, distribute, publish, reproduce, transfer, dispose of, recreate, modify, or create derivative works based upon or otherwise reveal or make available to any third party, directly or indirectly, for any purpose, except as provided in such contract; and
  • Indemnification, remedies, limitation of liability, and other provisions protecting your business enterprise for any damages resulting from a data breach or loss, in instances where such breach or loss are caused by the purchased software or the service provider.

Finally, the agreement with the service provider should include a Business Associate Agreement (BAA, as defined under HIPAA); however, please keep in mind that the BAA should acknowledge the changes mandated by the recent American Recovery and Reinvestment Act of 2009, as well as numerous new regulations to be promulgated by the Secretary of Health and Human Services under this Act.

 

 
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