Physicians have been slow when itcomes to incorporating e-mail to communicatewith their patients, and generallywith good reason. Privacy issues areat the forefront of their concerns, sinceunsecured e-mails from both patientsand doctors could be vulnerable tohackers and would violate HealthInsurance Portability and AccountabilityAct guidelines. Also troubling ishow doctors would be paid for timespent fielding e-mail questions frompatients. So far, third-party payers havelagged in allowing doctors to receivereimbursement for e-visits, althoughpilot programs set up by KaiserPermanente and Blue Cross/Blue Shieldof California have been well received.
A sticking point for payers is whetherthere is a quid-pro-quo for the moneypaid out for e-visits. If the use of e-mailcan cut down on the number of morecostly office visits, reimbursement mightwell be worth the expense involved.Another question is patient acceptance—whether patients will be willing to comeup with a copay for talking to their doctorsvia e-mail rather than in person. Fordoctors, another problem is that researchinto any beneficial effects of usinge-mail for patient communications isspotty. Although some studies show thate-mail does improve office workflow,others show that telephone call volumeremains unaffected when e-mail is used.E-mail will remain anunderused tool until a practical methodof insuring privacy and providing physicianreimbursement is put in place.