Monday, May 30, 2016

Email as Integrated Clinical Practice

Communication is a fundamental component of our relationship with our patients. When communications lag, patient care can also lag. Communication beyond practice walls has not kept up with advancements in modern communications. Currently, many feel that outreach communications cannot be used due to inadequate privacy and security (as per this report of a BC ER doc not notifying a patient of possible cancer for 11 months!). That argument no longer holds, as a fully modern, secure, and private messaging platform is available today, and it is time to embrace secure email as an integral part of clinical practice.


The evolution of medical practices, which are inherently highly communications intensive, has created opportunities to manage change to more efficient, more clinically beneficial, more patient-centric and more financially rewarding communications processes. Secure email is the medium that fulfills this opportunity.


The Clinical Benefits of Secure Email With Patients


Communications between doctor and patient (for specific diagnosis and treatment conversations), or practice and patient (for scheduling, follow up, or referral processing) are equally critical. Efficient treatment can follow efficient evaluation resulting from efficient scheduling, all of which begin with efficient communications.


Our communications with patients may be considered into five general categories:


  • Scheduling and Follow up - reminders, recalls, etc
  • Advice - directing current or de novo issues
  • Summaries/outlines - referrals, confirmations, personal summaries
  • Engagement - patient owning/accessing own info
  • Efficiency - enhance the overall efficiency of your practice


Examine how email improves scheduling. People are much more likely to check their email inbox than their voicemail box, making email much more efficient for scheduling, rescheduling, and confirming appointments. In some clinics, staff spend 30%-50% of their day phoning patients regarding appointment scheduling. Email can significantly reduce dial time by consolidating multiple phone calls into one detailed message.


Not all advice requires an office visit. You can make patients’ lives easier by directing appropriate issues asynchronously via secure email rather than funneling them through the waiting room. This can lead to more expedient advice follow up which can lead to better patient satisfaction and outcomes. In return, you free up appointment space to reduce wait times or even allow you to roster more patients.


Summaries and outlines should be readily available to patients. Secure messaging and email facilitates quick delivery of protected health information so that patients can share consolidated records easily. This moves us toward the ideal scenario which is that, patients have direct access to their own information and are facilitated to be empowered to do so by their healthcare team. Remember - Patients fundamentally own their health information regardless of source and archival medium. Physicians and other caregivers who store the info are custodians of the information, and are only owners of the medium.


Increased engagement increases patient satisfaction. Using secure email to send reminders, recalls, bookings, requisitions, results and other such sensitive information can greatly enhance a physician’s care, connection with, and management of patients. The easier it is to connect and communicate with your practice, the more satisfied patients are with your service. Adding convenient and familiar lines of communication that fit with how patients want to communicate strengthens your relationship with them. Additionally, written messages and searchable email threads can increase clarity and compliance.


Increased practice efficiency. One of the past concerns practices had about adding email communications is that it would add workload. While it is true that some staff and physician time will need to be re-directed to messaging each other and directly with patients, the former is already being done and the latter is something that should be done. Structured secure messaging within a practice can create efficiencies in care coordination and reduce errors. Secure messaging to a patient can reduce time-consuming telephone messaging, automatically generate a message log, reduce missed messages, reduce effort duplication, and remotely deal with small problems while they are still small.


Direct to Practitioner Communications


Of course, communications with the rest of your patient’s healthcare team is also important. Secure email is a much faster, more trackable means of coordinating care with other providers, practitioners, support.


  • Doctor - investigations (specialists, radiology, lab, etc)
  • Doctor - care providers (Home Care, pharmacy, nursing home, physio, etc)
  • Doctor - supporters (family, insurance, lawyer, etc)


Using secure email with other healthcare professionals accelerates referral response times, and creates a shared, referenceable, and updateable record of care.


Financial Considerations


In an increasing number of jurisdictions, such as Alberta, physicians are being compensated for secure email communications with patients and other clinics. Unlike phone consult billing codes, using email is transactional and can be time controlled with responses written and sent when possible as required.


Adopting email as your de facto patient communication channel extends new billing opportunities and creates roster room. Many patient follow up questions or concerns, or prescription refills can be addressed quickly using secure email - compressing what would have required several physical office appointments into one or two time slots. The Conference Board of Canada reports that by communicating with patients electronically to access lab results and request prescription renewals over 50% of physical office visits in Canada could be avoided. The resulting increase in appointment availability can reduce wait times, and make room on your roster for more patients.


In addition to an email insured billing code covering some of the basics of clinical care, there are uninsured services that can be offered on the foundation of a secure messaging platform.  Important services such as after-hours advice, prescription reviews/renewals, provision of chart content, travel advice, clinical summaries, health newsletters are examples of services that patients may value sufficiently to pay ad hoc or subscription fees.


The Case for Secure Email in Your Clinic


Along with greater practice outreach and reduced staff time, there is equally greater patient satisfaction, potentially greater compliance, possibly improved health outcomes, and increased billing opportunities.


Simple two-way communications may be further enhanced by the inherent organization and categorization through threading. Multiple recipient capabilities of the secure email medium expands coordination of care to a much larger care circle around the patient. By integrating secure closed-loop communications with existing workflows, internal practice management and patient care coordination may be automated for even greater efficiency gains.  

Secure email is not only a communications means for a medical practice, but can form the basis of the networking of a physician with his/her practice and with patients. Where the EMR has been a useful scheduling and information recording/archiving tool, secure email is the tool that makes everything connect together and involves the patient in their own care.


By: Dr. Norman Yee, BSc, MD, CCFP, FCFP Dr. Yee is a family physician with expertise in Electronic Medical Record (EMR) management. He sits on Provincial and National organizations responsible for developing innovative IT capabilities to support patient care. Dr. Yee is a Clinical Assistant Professor at University of Calgary Medical School and a member of the Medical Informatics Committee of the College of Physicians and Surgeons of Alberta and of the Physician Reference Group for Canada Health Infoway.

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