Thursday, October 27, 2016

The Clinical Power of Doctor to Patient Collaboration - By Dr. Norman Yee

Communication with patients is foundational to our clinical relationship and encompasses many interactive aspects of our services, ranging from face-to-face Osler-inspired encounters to telephone calls to conferencing with family or care teams to emails. The spectrum of care and interactions is sufficiently broad to benefit from multimodal communications.

Physicians have a wealth of traditional experience in many aspects of physician to patient communications, but some of us have been hesitant to add another mode such as email, and we worry about an assortment of potential pitfalls. Yet, a growing number of our patients have incorporated messaging in much of their lives.

With the advent of secure email and secure messaging, we have the opportunity to integrate securely, expeditiously and efficaciously with patients regarding their health using their preferred interactive medium. This discussion will look at the benefits, concerns and potential collaborations using secure email as the basis for enhanced clinical care.

Recorded information


Health is complex. Even something as simple as a cold or a papercut may be layered with many issues such as history of smoking or asthma, fever, tetanus status, anticoagulation, etc. The presence of a longer problem list of past or concurrent issues increases complexity. Now, the complex and layered information transfer between a patient and physician can be facilitated with secure email by securely sharing the information before and after a clinical encounter.  

Of course, we can skillfully sort our way through the information gathering, collation, and synthesis to come up with a comprehensive management approach. Secure email provides a platform agnostic channel, independent of EMR, for the collection and exchange of protected health information regardless of where or how it was created. Interested and better informed patients are able to follow us through to compliance with secure inclusion in our processes and information.

Organized information


More and refined information is often helpful in managing the clinical presentation. Patient information collected via secure email before a visit can help better define the presenting reason for visit, aid in triaging, and facilitate proactive requests for further information. Outlining useful information, directions and follow up to patients improves compliance and outcomes. Ideally, this information would be shared securely at the conclusion of each visit, or even in place of a visit when possible.

Threaded communications


The continued evolution and expansion of team-based care has increased the complexity of cross-communications between team members and patients. The ability to hold ‘threads’ of messaging and information exchange between appropriate providers and the patient simultaneously translates into better coordination of people, services, and management. It also provides a useful record of activities for all parties involved.

Asynchronous communications


Another advantage of messaging is the automatic asynchronous nature of the medium.  It is not intended to be an instant or urgent communications medium, but one that is inclusive and that can be dealt with at the convenience of the recipient. This will keep everyone informed and updated at such time that each can get to the case — no need to coordinate schedules, which translates into a reduction of no shows and speeds the sharing of information.

Timely communications


For more urgent communications, the common sense use of phone calls always applies. For less urgent communications, secure messaging provides more information to more people at more convenient time than any other form of medium. It also allows providers and patients to contemplate the information and actions to ensure the optimal care. Using secure mail allows for the inclusion of all pertinent information in the first contact rather than playing a prolonged game of phone tag to deliver sensitive messages.

Supplementary relationship


Reaching out to patients with secure messaging improves our ability to manage patient relationships, and increases their confidence of our coordinated care. A tighter relationship improves compliance, outcomes and satisfaction. The paradigm of patient care is evolving with the increased mobilization and democratization of health information. As our patients have more access to information, self-generated sensor data, and more options in caregivers, a more engaged relationship with our patients will serve to enhance our relevance and value to them.


Norman Yee, 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.



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