While a recent survey by HarrisInteractive shows that 77% of patientswould like to be able to contacttheir doctors by e-mail, an AMApoll shows that just 25% of physiciansuse e-mail to communicatewith their patients. The rest are hesitantabout virtual office visits, citingsecurity, liability, and privacy concerns.Recent guidelines developedby the eRisk Working Group forHealthcare, a consortium that includesthe AMA and several malpracticeinsurers, seem to be aimedmore at helping doctors practice safeonline medicine than doing awaywith their worries. The AMA, alongwith several other physician specialtygroups, is the sponsor of Medem, Inc(877-926-3366; www.medem.com),which provides doctors with Web services.Medem, which has about80,000 doctors enrolled, recentlylaunched a program that lets doctorscharge a fee for online consultations.
The guidelines advise doctors tobe explicit about any fees the patientmay incur and inform physicians thatthe charges may not be coveredunder the patient's health insuranceplan. In addition to some other commonsense recommendations, suchas limiting online visits to a securenetwork and letting patients knowabout potential privacy risks, one ofthe main thrusts of the guidelines isthat doctors should limit e-mail consultationsto patients with whom theyhave already established a doctorpatientrelationship, especially ifthere is a fee involved. According tothe consortium, doctors should avoidmaking online diagnoses of new conditionsor advise treatment for theseailments. Doctors who do so wouldbe exposed to greater risk of malpracticelitigation.