Patient-Physician Email Communication Is Effective

Patients prefer patient-physician email communication, which takes less time for physicians than does telephone messaging.

"The 2001 Institute of Medicine (IOM) report Crossing the Quality Chasm: A New Health System for the 21st Century called for care that is based on continuous healing relationships," write Paul Rosen, MD, MPH, MMM, and C. Kent Kwoh, MD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. "In its first rule on redesign, the IOM report stated, ‘Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits.’"

The goals of this study were to evaluate the patterns of patients using a patient-physician email service, to measure physician time required to answer a patient question via email vs via telephone, and to assess the satisfaction of families who were provided email access to their child’s rheumatologist.

During a 2-year period, a consecutive series of the families of pediatric patients were offered email access, and the investigators collected data on patient email use. Studied parameters included urgency, subject matter, and volume of the message; time of day of messaging; and timed duration with use of a stopwatch of the pediatric rheumatologist’s email interactions and telephone interactions with patients. After 1 year of enrollment in the patient-physician email service, families were mailed a 12-item satisfaction survey concerning their email experience.

Of 328 families who were offered patient-physician email access, 306 enrolled, and 121 used the service. Of all patient emails sent, 40% were sent during nonbusiness hours, and 5.7% were urgent (notification of disease flare or of new symptoms or parent expectation of same-day response). Only 0.002% of the emails to the physician required emergent attention.

On average, the physician received 1.2 emails per day from patients. For the physician, answering patient questions by email was 57% faster than by telephone. Families who responded to the survey reported that patient-physician email improved access to the physician as well as quality of care, and they did not believe that patient-physician email distanced them from the pediatrician.

"Patient-physician e-mail is a service that patients will use given the opportunity," the study authors write. "The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service."
"For some physician practices, a staff-based triage system may be more efficient than a non–triage-based system," the study authors conclude. "However, the comments of the families who used the service demonstrate that PPEM [patient-physician email] is one method of improving communication and providing consumer-driven health care…. Given the nature of family-centered care for pediatric patients, pediatricians and pediatric subspecialists are well positioned to transform health care delivery."

Practice Pearls

• Families who used a patient-physician email service reported that patient-physician email improved access to the physician as well as quality of care. They also believed that email facilitated understanding of medical tests, and they did not believe that patient-physician email distanced them from the pediatrician.
• Only 0.002% of emails sent to the physician required emergent attention. Almost all physician responses were sent within 24 hours. For the physician, answering patient questions by email was 57% faster than by telephone.

Pediatrics. Oct. 2007;120:701-706.
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