THCB

Why Doctors Still Don’t Text or E-mail their Patients

Niam YaraghiAccording to the Nielsen survey earlier this month by the Council of Accountable Physician Practices and the Bipartisan Policy Center, the majority of medical providers in the United States still do not use emails or text messages to communicate with their patients, despite the fact that such communication channels are in very high demand from the patients.

The survey results are appalling. After all, when you receive text message reminders about your upcoming credit card bill or ask your airline a question about your flight reservation via email, why can’t you communicate with your doctor in the same convenient way? Why are we still using the technology of the 20th century to communicate with our doctors in the 21stcentury?

The answer has three sides to it: Economics, technology management and regulations.

Physicians, like you and me, have to make a living. In the current fee-for-service payment system, doctors are only paid for the services for which they can submit a claim to the insurance companies. As you may have guessed already, doctors are not always reimbursed for the time and energy that they spend on emails and text messages. If they can answer your question during an office (which pays more than online consultations) why would they answer it in an email?

Information technology has revolutionized all industries but healthcare. Everyone, except doctor and hospitals, had to either jump on the IT bandwagon or go out of business. The lack of economic incentives in the fee-for-service payment model prevented physicians to seriously consider implementing such technologies in their practices. Even larger medical providers rarely have a well-defined digital strategy. As a result, while other industries now have learned how to adopt, use and manage information technology, healthcare sector lacks the required business expertise for successful implementation of information technology.

While there are hundreds of products and thousands of experts for customer relationship management in virtually every other industry, the healthcare sector seems to lack the required technical and business expertise for patient relationship management. Even if medical providers want to better communicate with their patients, they neither have the tools nor the expertise, at least as compared with other industries. If these technologies are not correctly implemented and integrated with the workflow of medical providers, they will become a problem rather than a solution. Imagine a doctor who is constantly distracted by the flow of emails and text messages form his patients.

Finally, the misunderstanding of laws and regulations which are intended to protect patient privacy in healthcare further inhibits medical providers to fully embrace IT. The Health Insurance Portability and Accountability Act commonly known as HIPAA is a good example of such acts. I believe HIPAA is a fairly well-designed act and does pretty well in protecting patients’ privacy, but as David Harlow points out, there’s a lot of confusion about HIPAA on the part of medical providers and tremendous resistance to open communication even when authorized and demanded by patients.

These factors have created a situation in which medical providers do not have the incentive to better communicate with their patients, and even if they want to do so, they rarely know how and are often concerned about the possible legal consequences of their actions. Given these barriers, the fact that even a small percentage of medical providers are using these communication technologies is surprising to me.

Despite the lackluster survey results, I believe that medical providers will use modern communication tools in the near future. As value based payments replace the fee-for-service models, providers will have much larger incentives to communicate with their patients. This demand from the side of medical providers will drive the IT sector to develop the required tools and very soon the healthcare industry will learn how to successfully integrate these technologies into their daily routine. The generation of young and digitally native doctors will help expedite this process.

Niam Yaraghi is a fellow at the Brookings Institution. This post first appeared in the Brookings Tech Talk Blog.

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healthcare_athomeToryBrandon_BetancourtPerryGeorge Dawson, MD, DFAPA Recent comment authors
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healthcare_athome
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The outlook which u shown here is practical and agreeable. Read till the end..

Tory
Member

I could see using texts/email for patient reminders, appointment setups, etc, but you start to get in a grey area when you’re delivering patient information through these types of communications. I’ve read the HIPAA guidelines and it doesn’t address these situations specifically, so maybe once there’s more clarity on the situation, doctors offices will be more open to the idea.

Brandon_Betancourt
Member

On the economic front, I’d argue it isn’t about the fee for service model, but instead about why health insurance companies and patients are not willing to pay for the doctor’s time?

On the tech front, I’d add that a challenge doctors face is patient adoption of patient portals.

HIPAA. Great for patients, difficult for providers. Doctors are inherently cautions. The threat of HIPAA violation fines is enough to deter providers from taking chances.

@pediatricinc

George Dawson, MD, DFAPA
Member

Two answers really:

1. Lack of security – most of the secure systems are awkward and patients are reluctant to use them.

2. Lack of reimbursement is certainly an issue but the larger issue is the risk of an ongoing conversations via e-mail.

Both factors lead EHR manufacturers to prove a limited but secure interface for communication with physician or the clinic team.

Perry
Member
Perry

3. Medicolegal concerns.