SPECIAL TECHNOLOGY SECTION
THE CONNECTED PHYSICIAN

Patient e-mail: A growing trend

New uses of Web communications with patients are emerging.

The range of options in physician-patient connectivity continues to grow. A few years ago, the connection focused on requesting refills and appointments online. Now, more doctors are starting to exchange e-mails with patients, and more health plans are beginning to pay for these communications. At the same time, new uses of Web-based connectivity are emerging, ranging from personal health records to disease management to mail-order refills.

To be sure, online communication between physicians and their patients has a long way to go. Keith MacDonald, a consultant for First Consulting Group in Boston, estimates that

only 10 to 12 percent of physicians e-mail with their patients today. Many other doctors are deterred by "their fear of the impact on productivity, and the fact they're going to have more work and not get paid for it." But studies have shown, he says, that patient e-mail doesn't overwhelm doctors if it's handled correctly, and that it can make physicians more productive by reducing unnecessary phone calls and visits.

MacDonald thinks more physicians will accept patient e-mail. One reason is the emergence of secure messaging services, including those of HealthyEMail, Medem, and RelayHealth. Also, guidelines from medical societies and liability insurance carriers have clarified how to conduct online communications without risking lawsuits, he notes. While only a handful of health plans are paying doctors for online visits, he says, some practices are charging their patients an annual fee for e-mail access to their physicians.

A growing number of EMR vendors are also active in physician-patient connectivity. WebMD's Medical Manager, for instance, recently acquired the Little Blue Book, which includes a portal called MDHub that permits online refill requests. NextGen's EMR is linked to a similar patient portal. Under NextGen's recent deal with RxHub—a co-venture of AdvancePCS, Express Scripts and Medco—a patient could request a refill online, her doctor could approve and document it in his EMR, and the drugs could be delivered to the patient's home within 24 hours.

Cerner, which makes inpatient and outpatient EMRs, is developing a patient portal as part of its community-wide connectivity experiment in Winona, MN. Two years into the project, most of the town's 50 doctors are just starting to implement their EMR systems. But 9 percent of area residents have already signed up for Winona Health Online, which allows them to communicate with their doctors, receive lab results, and maintain a personal health record on a secure Web site.

Since patients with chronic diseases are most interested in online communications with caregivers, Cerner is starting to focus on disease management. Diabetic patients who've enrolled in its first "condition center" enter insulin dosages in an online diary, and their home glucometers transmit blood-sugar readings over the Web to a diabetes educator. Cerner plans to launch similar online monitoring programs for people with asthma and congestive heart failure.