The Role of Electronic Communication in Providing Care

Our society is moving rapidly toward communicating electronically using email and social networking tools such as Twitter, FaceBook, MySpace, etc. It is inevitable that this form of communication will have a greater impact on the delivery of heath care, especially for Primary Care services, as more patients use electronic means to communicate with their health care providers.

In theory, the electronic communication was supposed to reduce the number of phone calls that a doctor receives from patients seeking medical advice or for follow-up after an in person visit. At first this sounded great as it was assumed that doctors could respond more quickly to emails than engage in lengthy phone consults. However, as with many great ideas, there are unintended consequences. While there is some evidence that the number of phone contacts between patients and physicians has decreased, the complexity of the email communications have increased to a point where some patients are seeing this communication as a substitute for a face to face visit with their doctor. Clearly minor problems can be addressed in a quick and safe manner with a very succinct response by a doctor. Other more complex situations are a different story.
Obviously, in these cases the correct response is to not provide a detailed response but to indicate that a face-to-face visit is in order.

There are a series of questions that get raised in this brave new world. Where is the line? How do you define medical standards? How do you educate patients regarding the appropriate use of electronic communication? How do you keep this communication secure and private? How does a doctor get paid for providing this service?

At this point, some clinical practices, like the Marino Center, have established a secure messaging system that allows, and some might say encourages, patients to communicate with their doctors through an electronic format. However three significant challenges arise; one is the increased volume of emails and the time necessary to respond, the second is the length and complexity of the communication requiring more time and thought to respond, and the third is the lack of compensation for this service. While patients may like the convenience it does place an added burden on the doctor. This was not supposed to be the case.

Possible solutions the electronic communication challenges are to:

Not permit electronic communication at all
Limit the length of the message (like Twitter)
Assign a triage nurse or administrative assistant to screen all electronic communication and respond directly to the simple questions and direct patients to make an emergent or urgent visit, if warranted.

Under any circumstance, adequate payment for these services by third party payers should be required. This would provide an incentive for practices to develop this form of care delivery, which will happen one way or another.