Doctors offer e-mail services to reduce office visits

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House calls may be a rarity among today’s physicians, but for many people, their doctor is now just a mouse click away.

Many health care providers have started offering online services in which patients can access doctors through e-messaging systems or websites that allow them to ask simple questions and make routine requests.

Eric Liederman, medical director of clinical information systems for the UC Davis Health System, said there has been an increased need for alternate means of communication in the past few years.

“Secure web-messaging between doctors and patients is associated with a substantial decrease in inbound phone call volume, a marked increase in the number of patients that a doctor can see in the office each day, and the resulting improved access to care created by shorter phone hold times, more office appointments, and a new electronic way to contact the doctor’s office, (all of which leads to) high patient satisfaction,” Liederman said.

Liederman also said using e-mail communication is beneficial for both doctors and patients.

E-messaging provides substantial benefits to doctors and patients because it provides a more convenient and efficient communication channel for some types of issues, such as scheduling appointments, handling refill and referral requests, answering clinical questions about minor conditions or ongoing problems, or answering administrative questions, such as about bills, Liederman said.

Liederman said he uses the same Internet-based communication system as Blue Shield of California, which is RelayHealth.

“The web-messaging system we use has task-specific templates to guide patients to provide the necessary information,” Liederman said. “The clinical templates, called ‘webVisits’ by RelayHealth, are condition (and) symptom-specific, have multiple choice questions and branching logic, and therefore deliver much more thorough and specific information to the doctor than a patient normally would.”

“Here at Blue Shield, we use RelayHealth to connect our patients and doctors online,” said Patrice Smith, director of Corporate Communications at Blue Shield of California. “They can talk about a variety of different things, and it’s encrypted for privacy. (RelayHealth is good for) making appointments, getting refills, lab results, and medical advice for non-emergent conditions. Patients pay an office visit co-pay (for online exchanges), and the doctor is reimbursed. Doctors are reimbursed for their time, ranging from $10 to $25, depending on the plan.”

CSUN’s Klotz Student Health Center will soon be starting its own E-Health service, which is currently in-development and should be available for student use by this summer.

The Internet-based health service will consist of a committee of health care providers who will answer questions depending on their areas of expertise, said Sharon Aronoff, Student Health Outreach health educator at the Klotz Student Health Center.

“A panel of doctors and nurse practitioners with different expertise will filter questions,” Aronoff said.

Dr. Linda Reid Chassiakos, director of the Klotz Student Health Center, said that the convenience and ease of service is important to students.

“Students look for resources 24-7,” she said. “E-Health provides communication … and support at the student’s convenience.”

Despite the potential positive effects this method of medical communication has had on health care services, doctors emphasize that it will not and cannot replace in-person doctor office visits, said Chassiakos.

“A service like this is not meant to replace face-to-face health care and education,” Chassiakos said. “We encourage students to use a service like this as a first step.”

Liederman had a similar opinion.

“(E-messaging) does not preclude or detract from other methods of care, such as office care, phone care, or hospital care,” Liederman said. “Many times, our physicians respond to clinical e-messages with a request that the patient be seen in the office.”

Liederman said he does not see much likelihood or risk for dangerous misjudgments on the part of doctors interacting with their patients online, likening it to the practice of doctor-patient telephone contact. Using the Internet to assist patients is often less risky than telephone conversations, he said.

“E-messaging removes the risk of transcription error that can occur when someone takes a message to give to the doctor,” Liederman said. “Every word in an e-message is the patient’s.”

He said that in three and a half years of using medical e-messaging, he does not know of an instance in which patients with life-threatening conditions mistakenly tried to seek emergency medical care on the Internet.

“The system also helps prevent (the) use of e-messaging for urgent problems by reminding patients multiple times during message creation not to use the system for that purpose,” Liederman said.

Office visits are not always necessary, and many problems can be resolved without interpersonal contact, he said.

“Doctors have been providing care to patients at a distance, via the telephone, for over a century, and with good reason,” Liederman said. “A substantial body of evidence has demonstrated that 80 percent of diagnoses are made by history alone.”

He said that for the other 20 percent, the doctor’s office remains, and will remain a constant necessity.