Clinician -Patient Electronic Messaging, an opportunity to improve healthcare communication.
More and more patients expect to be able to communicate with their doctor via email. Messaging via secure websites makes it easier to accommodate relatively sensitive clinical information this way, and has the added benefit of creating documentation in the health record- a written record in the patient’s words. Electronic messaging is asynchronous so that it can be fit into a busy clinicians day, and patients appreciate being able to spend more time formulating their questions and concerns. Electronic messaging allows links to reliable web based informational resources that can also be a source of efficiency and patient centered care.
Clinicians worry about endless, time consuming emails, but experience has shown that this is seldom an issue. In fact, email may allow physicians to answer questions with less time compared to telephone calls.
Guidelines for using e-mail are available. The American Medical Association has articulated appropriate policies, confidentiality and ethical issues in a succinct document referenced below.
Reimbursement strategies for electronic messaging remain a challenge. Some payors compensate for 0074T coding, standards and criteria are defined, but many providers remain uncomfortable distinguishing between informational messaging and billable eVisits. Electronic messaging likely provides an opportunity for more efficient and continuous provision of health care, however.
Tips for effective patient e-mails and e-visits:
• Assess the emotional impact of the message and make a plan- is e-mail the right medium for this communication? An emotional topic may be better communicated in person or by phone, however patients may to a surprising degree prefer the emotional distance that e-mail affords in some circumstances.
• Match formality with what has been established during encounters. E-mail that is more or less formal than the established relationship is disconcerting. “Dear” is more formal and generally acceptable. “Hi” is less formal. “Greetings” is acceptable. “Sincerely” is formal and may sound computer generated. “Regards” and “best wishes” are currently well accepted.
• Make it easy to understand information and know what to do next. Use bullets or lists, short sentences, with punctuation, and white space. Do not overestimate health literacy issues- the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions (Institute of Medicine). A reference for the SMOG readability formula is listed.
AMA (YPS) Guidelines for Physician-Patient Electronic Communications [1]
Delbanco T. Electrons in flight--e-mail between doctors and patients. N Engl J Med. 2004 Apr 22;350(17):1705-7.
Komives EM. Clinician-patient E-mail communication: challenges for reimbursement. N C Med J. 2005 May-Jun;66(3):238-40
Rosen P. Patient-Physican E-mail: An Opportunity to Transform Pediatric health Care Delivery. Pediatrics. 2007;120:701-706.
An Author's Guide - Readability Testing, SMOG (Simple Measure Of Gobbledygook)[2][3]
