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【medical-news】电子医疗时代的医患沟通
Volume 356:2451-2454 June 14, 2007 Number 24
Communication between Physicians and Patients in the Era of E-Medicine
John H. Stone, M.D., M.P.H.
This year, my clinic began inviting patients to use a secure Internet link to communicate with physicians and staff members. Self-preservation was high on our list of reasons for establishing online communication. Our patients had become accustomed to contacting us through myriad routes: the clinic telephone, our individual office lines, the hospital paging system, our cell phones, the clinic fax machine, and in some cases, our home telephones. Secure Web messaging about routine issues was an attempt to direct round-the-clock communication into a manageable channel.
Even before we initiated such messaging within a broader model of e-medicine, many patients had begun to use standard e-mail to contact us. Our hospital administrators, however, did not permit us to respond. Standard e-mail was incompatible with our existing electronic health records (EHRs) system and would therefore have been difficult to archive. But the larger problem was that the use of standard e-mail to communicate with patients was illegal — a violation of the Health Insurance Portability and Accountability Act. Patients' privacy could not be guaranteed because our replies would not be secure outside the university's firewall. Armed with strong motivation to enter the electronic age and full awareness of the need to protect ourselves and our patients from the hazards of e-medicine, we ventured forth cautiously into the online world.
In addition to secure Web messaging, the e-medicine model we adopted comprised four major types of services: online appointment scheduling, electronic prescription refills, general messaging capabilities, and "Web visits" with physicians. General messaging permits patients to ask simple questions electronically, obviating many telephone calls (e.g., "Should I have a chest x-ray before my next visit?"). In contrast, Web visits are structured consultations focused on nonurgent chief complaints (e.g., cough), involving menus of questions tailored to the problem, brief answers by the patient, and a response from the physician provided within a certain period.
With the growing acceptance of e-medicine by third-party payers, a quiet revolution has begun. Aetna, Cigna, and other insurers now reimburse physicians for Web consultations in Florida, California, Massachusetts, and New York. Although the providers who are reimbursed even in these states remain a minority, early studies indicate that e-medicine methods improve the productivity of providers, reduce the number of office visits, and save money.1 The field is evolving swiftly; during the next few years, patients, staff members, medical educators, doctors, hospital administrators, insurance providers, and companies that offer secure Internet services will shape the future of e-medicine.
Patients who are comfortable with the Internet delight in e-medicine's prospect of convenient access to doctors. Most patients became frustrated long ago by telephone calling trees, voicemail tag, and interminable waits on hold. A Harris Interactive survey of health care consumers, published in September 2006, indicated a strong preference among a majority of respondents for access to a variety of e-medicine technologies in communicating with their doctors and hospitals (see table). Even so, many patients do not expect to pay for this expanded access.2 In states in which Web consultations with physicians are not reimbursed, prices for "Web visits" typically range from $10 to $25, and patients pay the full cost. Requests for prescription refills and queries about test results, viewed as extensions of visits, are generally free. The expenses that patients incur in attending clinic visits — time away from work, the cost of travel, the price of parking, and the copayment — make Web visits for nonurgent problems an attractive option for some. Nevertheless, third-party payers will have to begin underwriting the cost of Web visits (minus copayments) before patients avail themselves widely of this option.
Staff members in medical offices, who are usually the first point of contact for patients, tend to embrace e-medicine wholeheartedly. Despite communication advances in most other spheres of human endeavor, communication about patient care has remained dependent on telephones, fax machines, and paper. To refill prescriptions over the telephone, staff members must not only field requests from patients but also establish contact with pharmacies — a process fraught with delay, duplication, and frustration. The use of e-mail for routine tasks, such as prescription refills and appointment scheduling, reduces clinics' call volume (see graph),1 which gives staff members more time to serve patients with urgent needs.
E-medicine may also enable hospitals to improve transitions of care for patients. In the era of hospitalist medicine, the doctor caring for patients in-house is seldom the one who will follow them after discharge. Hospital administrators and hospitalists are concerned about fumbling the handoff.3 Physicians in emergency departments have similar concerns. Flawed transitions of care can lead to mistakes that have serious health consequences for patients and leave hospitals and physicians facing litigation. Such gaps in care could be bridged through the use of e-medicine networks that permit hospitalists, emergency department physicians, primary care providers, pharmacists, and patients to converse easily with one another.
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作者:admin@医学,生命科学 2011-02-28 05:11
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