Too early for a practice online?
My assistant had explained it to him the week before, but he didn't get the summary sheet I usually hand out. Rather than give him instructions over the phone, I offered to email him within five minutes.
He was pleasantly surprised. A doctor had never emailed him before.
With the rest of the world hooked on electronic communication, doctors sometimes seem like the last holdouts. Most doctors I know seem unwilling or unable to make even email part of the way they practice medicine.
I think there are two main reasons. The first is that email is another stream of information on top of phone calls, faxes and electronic pages from the hospital that the typical primary care doc has to contend with every day.
The other factor is the privacy and security laws known as HIPAA3 that scared docs from trying something new. They got the message you could be penalized for doing communications in the wrong way, so it's easier to not go there at all.
Yet some surveys indicate that 40% of U.S. patients would switch to email-enabled doctors if they could.
My small practice jumped onboard three years ago. We figured we could use the Internet to stay ahead of our larger competitors. We've had a Web site4 that supports confidential email and provides a secure venue for electronic visits with patients.
I thought if we built it, patients would log on. But I was wrong. Over the last three years they haven't. The patients who send me email prefer to use their regular, unsecure email.
When it comes to e-visits my patients don't seem to want another password to remember. And they really don't want to pay the $30 I charge for an online consultation and that their insurance doesn't usually cover.
Maybe patients don't use our email system because we provide good access by phone and in the office.
In retrospect, I should have surveyed my patients before I spent money on a secure email platform and state-of-the-art software for electronic consults. I guess I was a little too far ahead of the curve.
In some parts of the country doctors are using e-visits and electronic communication to good effect. Some are even getting paid for it. We aren't. Our local insurers, Medicare and Medicaid haven't embraced the idea.
Right now it costs my practice $1,800 a year to maintain our cool Web site. The company that provides it wants a $6 transaction fee for each e-visit, and 50 cents for every appointment and prescription refill I process with their software. We haven't come anywhere near covering our costs.
I checked with another popular company and they wanted a $3.50 cut from each visit. Giving 14% or more of e-visit fees to a transaction processor still seems too much.
The cost is too high for small practices for this to really catch on. The right combination of ease of use, price, security and connectivity to physicians' electronic records systems hasn't been found yet.
Many electronic medical record companies haven't integrated secure email into their products very well. And email integration, such as it is, often costs extra. The records company we use wants $50 per physician each month for secure messaging above and beyond the $3,500 we pay in annual software support costs.
Secure email programs can be had free, but they don't integrate well with physicians' EMR systems. Plus, patients find the added security process inconvenient.
There are lots of companies looking to make money from the interactions and communications between doctors and their patients. As a doctor trying to run a small practice it seems like everybody's got their hand in my pocket.
Some of my colleagues around the country who were early adopters of electronic communications have gone back to regular email with the patient's understanding that email is like a post card and that other people might see it.
Other doctors have a low-cost Web site and keep a paper copy of their patients' credit cards in a locked office file cabinet for billing e-visits and phone consultations. Some charge an annual fee for unlimited electronic communications. Others use PayPal to charge for electronic visits.
When my EMR allows patients to book appointments,
order refills and leave me a video, voice, or text
message with a cellphone we will have arrived. For
now, the expensive Web site that no one uses is
scheduled to come down by the end of the month.
This story is a good one and shows the challenges
that HCP’s face as they enter the digital world. In
order for “e” visits to take off several things are
going to have to happen;
1. Insurers are going to have to come up with a
reimbursement rate for physicians who attend to a
patients needs via online. There are going to have to
be several levels of reimbursement from a full
consultation to requests for refills.
2. Practice websites templates need to be developed
and deployed so that physicians can get their
websites up and running quickly with a minimum amount
of costs. Consumers can get online for as little as
$7.95 a month including the development of Websites.
This model needs to offered to physicians as well so
they can determine the importance of having a website
to their patients and practice.
3. Disclaimer language- Physicians need to work with
the AMA and the legal community so that patients can
go online with physicians and not worry about privacy
concerns. Physicians also need to know that for
online consults they covered against malpractice
litigation.
4.Be patient- In order to get patients to go online
with physicians doctors need to advertise that they
are online to their patients. Yes there are still
some patients who will want to go to their doctors
but remember that close to 40% of patients who have
had trouble getting in to see their doctors cite that
they don’t have the time. An online consultation
would surely allow them to do a virtual online
appointment.
The early adapters maybe paying a price for being
first to the table but this is the future of
healthcare for time pressed physicians and consumers.
It also allows pharma to uniquely integrate online
content for physicians practices. Imagine getting an
eMail from your doctor when you get home with
directions on how to take your new medication and
possible side effects? The key will be how many
physicians are willing to test this out before they
get it right and scaleable.