America has become a wired society, and when patients aren't in their doctors' offices for a visit, a large number of them are spending much of their day staring at a computer or smartphone. Yet, health care has been slow to harness that reality by using electronic communication to better manage patients.
A recent study by researchers at Weill Cornell Medical College found that despite the perceived benefits — improved access, patient satisfaction and time management — doctors still aren't using e-visits in a widespread fashion. Lack of payment, security concerns and resistance to change, from both patients and providers, remain barriers, says Tara Bishop, M.D., an author of the August Health Affairs study and assistant professor of public health and medicine at Weill Cornell.
"We live in a day and age that's driven by the Internet," says Bishop, a practicing internist. "I know I personally communicate a lot by email vs. any other form of communication during my day. But medicine is very much, and always has been, driven by the face-to-face visit."
Fairview Health Services, a seven-hospital system based in Minneapolis included in the study, has incorporated e-visits into its 45 primary care clinics. It's developed a formal program allowing patients to initiate contact with the system through the patient portal and target messages to the front desk for scheduling, nursing for prescription refills or their providers for specific questions.
Sally Wahman, senior vice president of operations for Fairview's clinics group, says she believes the program has paid off in satisfying patients, increasing panel sizes and helping doctors to manage their busy schedules. The top drivers included sinusitis, depression, urinary tract infection, upper respiratory infections, insomnia or coughing, Wahman says. It's past the time for health care to embrace the Web and catch up to "the rest of the world," she says.
Fairview gambled by waiting to figure out reimbursement after the electronic visits were added as an option. "We wanted there to be sort of a push, rather than waiting until we had all of our payers on board and contracts signed with all of them for this service," Wahman says. "We took some risks, in that we knew the market would demand it and the payers would understand the value, and they did."
Weill Cornell's study found that e-visits, though intended to free up time, often do not end up reducing the number of office interactions. All told, Fairview providers handled between 20 and 50 electronic messages per day, and an average of three to four formal e-visits per week. Physician groups have tried various strategies to battle burnout — using a team-based approach that has nurses triage e-communication or slotting specific times during the day for physicians to manage emails.
Not-for-profit insurer Medica has found a way to reimburse for e-visits through an arrangement tied to reduced co-pays. For example, a patient who has a regular co-payment of $30 might get a $15 discount if treated through an electronic means. Thomas Becker, M.D., medical director for care management and reimbursement at Minneapolis-based Medica, says it has mostly been larger health systems that have been willing to experiment. He believes that all health plans eventually will pay for e-visits, but it's important that doctors, too, think in a patient-centered fashion, and realize the value that e-visits can deliver to customers.
"Clinics were built for the convenience of the physicians, and not necessarily for the patients, and I think as the technology evolves, care can be delivered differently," he says.