Emailing Patients Doesn't Have to Cost Time and Money

July 21, 2014
Ed Rabinowitz

Although a majority of patients would choose a physician who offers email communication over one who does not, physicians are slow to change.

A large majority (93%) of adults aged 21 years and older said they would likely choose a doctor who offers email communication, according to Catalyst Healthcare Research’s national online survey on what patients want and expect when it comes to online versus traditional communication with their healthcare providers. Furthermore, 1 in 4 respondents said they would still choose that doctor even if there were a $25 per episode fee.

Danny Sands, MD, MPH, chief medical officer for Conversa Health, which encourages more frequent “light touches” between physician and patient in between office visits, admits he is a little surprised by how many patients want email communications.

“I haven’t seen numbers quite that large,” Sands explains. “A survey in 2012 by Harris Interactive gave a number of 65%. But recent surveys indicate the availability of online access is actually changing people’s selection of a physician. That’s important, because it’s changing behavior.”

But physicians are still slow to change.

The physician perspective

Sands has maintained a primary care practice for more than 20 years at Beth Israel Deaconess Medical Center in Boston, where he helped develop the nation’s first patient portal. In 1998, he also co-authored the first guidelines on how physicians should use email in patient care.

“I thought that as soon as we published those guidelines that all physicians would start using them right away,” Sands recalls. “But I was dead wrong about that.”

Sands says the latest surveys indicate approximately just 40% of physicians communicate with their patients via email. He says the reasons for reluctance are time, money, potential liability, and lack of knowledge about how to establish email communication with patients.

“We know that we receive lots of junk email, and many physicians believe they will get lots of email from patients,” Sands says. “And they are uncomfortable because they know they’re not going to be paid for this. Many physicians are already frustrated because they have to spend so much time talking to patients on the phone and don’t get paid for that. The only thing they’re paid for in the fee-for-service world is visits.”

Sands argues that communication is a core skill, and it’s also the cost of doing business. And for those physicians who believe that by addressing patient concerns via email they will see office visits decline, he believes the concern is misplaced.

“You have an endless stream of patients,” Sands says. “If there’s someone you can take care of [via email] and they don’t come in, that’s a low-intensity visit. You might as well have people in your office who need to be there, and you can bill higher for those fee-for-service visits. You can also decompress your waiting list, because your patients are waiting way too long to get into your office. And you want to make this easier for patients.”

Worth the time

Sands says that, based on several studies, the median length of a physician-patient phone call is 5 minutes, while the median length of an email interaction is roughly 2 minutes.

“If that’s true, you can make 2 patients happy in the time you could answer one phone call,” he points out.

The other key issue, Sands says, is that physicians believe they will be barraged by patient email. Data indicate, however, that for every 100 patients registered on a medical practice portal, physicians should expect to receive 20 messages a month—less than one per day. And since not all patients will be on the portal, the email volume should not be inordinate.

“As a fee-for-service provider, you care about patient satisfaction and pay-for-performance, and those will always improve if you have frequent light touches—light connection with patients between visits,” Sands says. “The best way to get a good outcome is to have strong collaboration between the patient and the provider. And these light touches through email can augment and accelerate that relationship better than infrequent, high-intensity contacts.”

Start small

Sands suggests physicians begin their entry into email communication by thinking about patient care as a collaboration. Start with a small group of patients—perhaps 50, initially—who you know and trust, and gain a comfort level. Then you can gradually expand the email offering to other patients in your practice.

He also directs physicians to a website he established, called the Electronic Patient-Centered Communication resource page, for advice on integrating email into their practice workflow. Another good resource is www.healthit.gov.

“I really encourage physicians to dip their toe in the water and sort of get comfortable with this, because it doesn’t hurt,” he says.