You’ve heard about patient engagement at your medical association meetings, on the evening news and in the national press. The idea sounds great in theory – exchanging e-mails or electronic messages with patients on the fly, focusing on prevention rather than treatment and developing a deeper bond and a more holistic understanding of your patients.
However, what this all sounds like to you is 2,500 more tasks to do, a whopping increase in the amount of unreimbursed time and a world of liability. Let me explain why you’re wrong and how patient e-mails actually save time, generate practice revenue and reduce your back-office workload.
I don’t have enough time to read patient e-mails.
In full disclosure, this data has been collected over the past three years from an active user base of 11,000 providers and 4.5 million patients. While there are specific patterns that emerge within each of the most popular specialties (primary care, ob/gyn, dermatology, orthopaedics and pediatrics), there are a few overarching themes. On average, physicians save 40 minutes of time per day when switching primarily to a mobile electronic messaging service.
How? The main savings come in the form of reduced voice mails and incoming and outgoing phone messages. Whereas mobile messages populate instantaneously on the smartphone and can be read and sent in seconds between patients or while “on-the go,” phone calls require listening to the message, recording the callback number accurately (which always takes me two or three times), calling the individual, introductions, information exchanges, etc. Also, by keeping messages to fewer than 500 characters, long-winded biographies of illnesses dating back to the mid 1980s are prevented and questions are kept short, yet functional and to the point.
The second way electronic messaging saves time is by providing a secondary layer of filtration. Whereas when a patient calls the office and asks to leave a voicemail for the physician, concerns regarding HIPAA and personal privacy typically prevent receptionists from diving too deeply into the concern. In nearly one-third of cases, however, voicemails left for physicians can actually be handled by ancillary staff. With an electronic messaging system, the messages can be initially directed to an office manager and/or physician extender who filters the messages, answers the appropriate ones and forwards MD-level questions on to the staff physician.
If my patients can e-mail me, then no one will come to the office.
Quite the contrary.
Roughly 80 percent of patients in the emergency room at any given time are directed there based on a recommendation from the primary care physician or their office staff. Eighty percent! Whether you are in a capitated, fee-for-service or fee-for-value system (ACOs, etc.), there is an incredible incentive to keep patients out of the emergency room (in non emergent situations). Patients who are able to communicate directly with their physician request appointments with significantly greater frequency and refer friends and family members to physicians who are accessible and reachable.
On average, physicians who accept and return messages generate 6.2 more patient referrals per month compared to when they did not accept messages. In a small case series where we followed certain specialty practices before and after adoption of mobile cloud-based messaging software, practices generated on average $45,000 in additional revenue. And at UCSF (my alma mater), they have looked into this more rigorously, publishing a study in the American Journal of Managed Care this year that indicated targeted messaging and early PCP contact can reduce potentially unnecessary ED visits, a frequently used metric for physician incentive in provider networks, ACOs and HMOs.
My Hotmail account is secure enough, right? And usually I just text message my patients for better security.
Well, no – and that’s not the best idea, either.
It’s surprising to me that I continue to meet so many physicians who use popular mail clients such as Gmail and Hotmail for patient messaging or rely on their smartphone messaging capabilities. The typical responses are, “I tried using a secure e-mail once, but it was too cumbersome” or “I only do it with patients I trust.” While these clients can and are being used for patient communication, the information is not encrypted, nor stored on private servers…and what may happen to you is what happened to a colleague of mine recently. Every patient (and everyone else) that he had ever e-mailed from his account received this message:
“I'm stuck in London, England right now, I came down here for a short vacation then i was robbed, worse of it is that bags, cash and cards and my cell phone were stolen at GUN POINT, it's such a crazy experience for me, I need help flying back home, the authorities are not being 100% supportive but the good thing is i still have my passport and return ticket but currently having troubles paying off the hotel bills and also getting a cab to take me to the airport. All i need is ($900 USD)….”
You can imagine not only the embarrassment, but the potential liability in these circumstances. It was not too long ago that Partners Healthcare was slammed with a $1 million fine for the possibility of information breach due to a lost file of patient names on a subway train. All in all, investment and use into privacy and secure communication is not only the right thing to do ethically, but it’s a wise business decision as well.
And lastly, regarding cellphone texting and security, while there are numerous issues related to handing out your cellphone number to patients and the storage of the information within those texts, there are plenty of legal (and not so-legal) entities that have demonstrated cracking four-digit iPhone codes in minutes. All in all, a second layer of authentication and the ability to shut the system down immediately if the device is lost or misplaced is needed to be fully HIPAA-compliant in the mobile age.
In summary, don’t be frightened about developing mobile technology and its ability to create stronger patient relationships. Embrace patient e-mails and save your practice time, liability and money.
Zachary Landman, MD, is the chief medical officer for Doctorbase, a developer of scalable mobile health solutions, patient portals and patient engagement software. He earned his medical degree from UCSF School of Medicine. As a resident surgeon at Harvard Orthopaedics, he covered Massachusetts General Hospital, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center.