You've got mail!

Emailing patients can be a boon for them — and you

By Sam Solomon

A patient of Dr Michelle Greiver's got a bad case of Montezuma's Revenge while vacationing in Mexico. "He had trouble with the usual — stomach problems, diarrhea — so he emailed me," recalls the Willowdale, ON, family doc. Wasn't she annoyed at the intrusion? Nope. She happily sent him a message right back. "I told him what to look out for, so he'd know if he should see a physician right away."

Dr Greiver, who's also a U of T researcher, has been emailing with her patients since 1999. She says it's been great not only for her patients, who relish the access they get to her inbox, but for her as well. "Some patients don't have to come in every time there is a problem," she says. "Sometimes they can be dealt with safely and effectively by email."

SNAIL'S PACE
Wired Canadian physicians like Dr Greiver are still a rare breed, says Canadian Medical Association (CMA) chief technology officer Bill Pascal, co-author of the CMA's 2005 online communications guidelines. "There are very few doctors who are emailing with their patients," he says regretfully. "My sense is we'll be experimenting more with this over time, but it's not prime time yet." By comparison, recent US studies show that about one in four physicians email with their patients. Most estimates put the Canadian figure significantly lower.

NET GAINS
In our increasingly globalized and electronic 21st-century economy, why have doctors been so slow to adopt email?

According to Dr Danny Sands, a Harvard University and Cisco Systems medical informatics researcher and Boston-area internist, many physicians worry that emailing patients will take hours out of their days. "Email seems like it could be disruptive if you haven't done it," he explains. But he has done it — since 1991 — and he's found it anything but disruptive.

"The reality is it takes a lot less time to communicate by email," says Dr Sands, comparing it to many kinds of office visits. And he has found that patients rarely abuse the privilege by bombarding him with emails. He admits it does happen occasionally: one patient's constant messages and stubborn refusal to just come into the office led to an email "pissing match," says Dr Sands, that only ended when she left his practice. But after 16 years of emailing with patients, Dr Sands has developed a rough guideline to estimate how many emails you might receive: for every 100 patients, you can expect to get about one email per day. "Doctors have to get over this fear of technology," he says. "Email will make patients happier and doctors happier."

Not only that, says Dr Sands, but it saves the health system money. One study conducted in the US showed that giving patients the option to email their doctors yielded $3 in savings per patient per month. That seemingly small figure can add up fast. A study conducted by Dr Sands at Cisco found that in setting up and running an email system, the savings (in more efficient use of doctors' time) exceeded the costs by 4.5 times.

MONEY MAIL
A common complaint is that emailing doesn't pay. The CMA's Mr Pascal intends to change that. "One of the things we're looking at now is if we can start to utilize the e-channel — email, websites, etc — in a way that supports care and in a way that doctors and institutions can get compensated for." Some large private insurance companies have already begun to test this in the US, he adds. But until provinces begin to pay for emailing, you can always bill patients for the privilege, the same as you do for filling out companies' insurance forms or faxing summer-camp physicals.

If Mr Pascal has his way, Canadian doctors won't have to wait long to be able to bill the provinces for emailing with their patients. "I think it's an area that could be an early win if we can get people to use it appropriately and get rules set up," he says.