Practice redesign and new payment methods would be necessary for electronic communications to be accepted and used by physicians in a clinical setting, according to recent study results published in Health Affairs.

“Leaders of medical groups that use electronic communication find it to be efficient and effective — they say it improves patient satisfaction and saves time for patients. But many physicians say while it may help patients, it is a challenge for them,” Tara F. Bishop, MD, assistant professor in the department of public health and medicine at Weill Cornell Medical College, stated in press release.

Researchers interviewed leaders of 21 medical groups and the health care staff of six groups that use electronic communications extensively, but varied in their approach. Electronic communications were used to communicate test results, to allow patients to request medication refills, appointments and to ask questions of their doctors in all six practices. Three practitioners used nurses, medical assistants or case managers to triage messages from patients, while patients could email nurses for refills or the front desk for appointments, as well as email their physician directly, in the three other practices.

Only one clinic charged patients for “e-visits”. Another clinic imposed $60 annual fee for unlimited electronic communication, which was later dropped because competitors provided the service for free. “Desktop Medicine time” was added to the physician’s schedules in two medical groups, while another allowed providers to decide how many patients they would see each day, providing time for electronic communication.

Overall, the researchers found the volume of emails that reached the physicians in the six programs varied from five to 50 daily. The primary disadvantage to using electronic communication was it created more work for providers. Study results showed barriers to use of electronic communications included physician resistance to change and lack of payment.

Although electronic communications reduced office visits for individual patients, clinics tended to send physicians additional patients to see, increasing, rather than decreasing, their workload. The researchers believe these issues could be addressed by team-based care that manages electronic communications and workload or by compensating physicians for electronic communication in ways other than traditional fee-for-service.

“Despite the fact that we found experiences with electronic communications were, on the whole, very positive in the groups we studied that have embraced this technology, we believe the big stumbling block to its widespread use around the country will be compensation,” Bishop concluded. “Until different payment models emerge, electronic communication is unlikely to be widely adopted by physician practices.”

For more information:

Bishop TF. Health Affairs. 2013;32:1361-1367.

Disclosure: This study was funded by a grant from the Commonwealth Fund.

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