Provider Attitudes toward
Patient-related E-mail

Dean F. Sittig, Stephen King, Brian Hazlehurst
Healtheon/WebMD, Portland, OR

Introduction

Patient-provider communication forms the basis of the modern healthcare system. The recent advent, and nearly ubiquitous availability of electronic mail (e-mail) has the potential to profoundly affect these encounters. We undertook this study to assess the attitudes of healthcare providers towards the use of e-mail to communicate with patients.

 

Methods

We sent surveys via e-mail to 1) all 200 members of The Informatics Review's mailing list of which approximately 75% are physicians, 2) all 300+ members of the Association of Medical Directors of Information Systems (AMDIS) mailing list of which all are physicians, and 3) all 1000+ members of the American Medical Informatics Associations Clinical Information System Work Group (CIS-WG) of which approximately 40% are physicians. Therefore, we estimate that the surveys reached approximately 850 physicians. Returned surveys were tabulated automatically.

 

Results

We received completed surveys from 46 individuals (appoximately a 5% return rate). A complete report of the results is available at the end of this report.

 

Discussion

While the return rate of the survey was considerably less than hoped for, we believe the results still offer some important information. In addition, one should be careful when trying to extend these results to a wider population since the survey population was selected based on their interest (and some might say extreme interest) in computers. Therefore, we believe that these results place a ceiling (i.e., no other sample population would be expected to have a more positive view of the utility of e-mail) on the actual value of patient-provider e-mail communication.

 

Survey Results

1. How important to you is the ability to exchange e-mail with your patients?
Choose one:
[ 23.9% ] a) Very important
[ 30.4% ] b) Important
[ 28.3% ] c) Somewhat important
[ 15.2% ] d) Not very important
[ 2.2 % ] e) Not important at all

 

2. What percentage of your patients has asked about exchanging e-mail with you?
Choose one:
[ 2.2% ] a) More than 75%
[ 0 % ] b) 50% to 75%
[ 4.3%] c) 25% to 50%
[ 23.9% ] d) 10 to 25%
[ 69.6% ] e) Less than 10%

 

3. How important to you will provider-patient e-mail be 2 years from now?
Choose one:
[ 39.1% ] a) Very important
[ 41.3% ] b) Important
[ 15.2% ] c) Somewhat important
[ 2.2% ] d) Not very important
[ 2.2% ] e) Not at all important

 

4. What proportion of your patients do you think will want to communicate with you via e-mail two years from now?
Choose one:
[ 8.7% ] a) More than 75% of my patients will want it.
[ 10.9% ] b) 50% to 75% of my patients will want it.
[ 39.1% ] c) 25% to 50% of my patients will want it.
[ 32.6% ] d) 10% to 25% of my patients will want it.
[ 8.7% ] e) Less than 10% of my patients will want it.

 

5. Do you think direct patient-provider e-mail communication has the potential to improve the patient's perception of the quality of the healthcare you provide?
Choose one:
[ 97.8% ] a) Yes
[ 2.2% ] b) No

 

6. Do you think direct patient-provider e-mail communication has the potential to improve the actual quality of healthcare you provide?
Choose one:
[ 84.8% ] a) Yes
[ 15.2% ] b) No

 

7. How do you think the widespread adoption of patient-provider e-mail would affect your daily workload?
Choose one:
[ 30.4% ] a) Add more than 1 hour per day
[ 23.9% ] b) Add less than 1 hour per day
[ 19.6% ] c) No difference
[ 19.6% ] d) Save me less than 1 hour per day
[ 6.5% ] e) Save me more than 1 hour per day

 

8. What percentage of your patients currently has your e-mail address? (i.e., you have specifically given it to them)
Choose one:
[ 22.7% ] a) 0%
[ 59.1% ] b) 1% to 10%
[ 4.5% ] c) 11% to 25%
[ 4.5% ] d) 26% to 50%
[ 4.5% ] e) 51% to 75%
[ 4.5% ] f) 76% to 100%

 

9. A possible special feature of provider-patient e-mail is the ability to e-mail a copy of the visit note to the patient. Assume that this could be done easily and securely. Which statement best describes your reaction to this possible feature?
Choose one:
[ 20.5% ] a) Great idea
[ 25.0% ] b) Good idea
[ 27.3% ] c) Not a bad idea
[ 27.3% ] d) Bad idea

 

10. Relating to the e-mail feature described above, to what extent would you use it?
Choose one:
[ 11.1% ] a) I'd use it for over 75% of my visits.
[ 13.3% ] b) I'd use it for 50% to 75% of my visits.
[ 13.3% ] c) I'd use it for 25% to 50% of my visits.
[ 44.4% ] d) I'd use it for less than 25% of my visits.
[ 17.8% ] e) I wouldn't use it at all.

 

11. Would you be more willing to e-mail your patients if you were reimbursed for it?
Choose one:
[ 71.7% ] a) Yes
[ 28.3% ] b) No

 

12. How much to make it worthwhile?
Choose one (amounts are in US dollars):
[ 46.3% ] a) Less than $10 per e-mail
[ 26.8% ] b) $11 to $20 per e-mail
[ 14.6% ] c) $21 to $30 per e-mail
[ 2.4% ] d) $31 to $40 per e-mail
[ 0 % ] e) $41 to $50 per e-mail
[ 9.8% ] f) More than $50 per e-mail

 

13. Do you have access to e-mail at:
Choose all that apply:
[ 97.8% ] a) Work
[ 97.8% ] b) Home

14. Do you have a separate professional and personal e-mail account?
Choose one:
[ 73.3% ] a) Yes
[ 26.7% ] b) No

 

15. Would you like to have a separate professional e-mail account?
Choose one:
[ 82.1% ] a) Yes
[ 17.9% ] b) No

 

16. How do you think the use of patient/provider e-mail affects your medical/legal liability?
Choose one:
[ 6.5% ] a) Increases it a lot
[ 30.4% ] b) Increases it a little
[ 50.0% ] c) No difference
[ 4.3% ] d) Decreases it a little
[ 8.7% ] e) Decreases it a lot

 

17. Have you ever exchanged e-mail with a patient of yours?
Choose one:
[ 80.4% ] a) Yes
[ 19.6% ] b) No (Go to question #24)

 

18. Do you keep a record of all your patient-related e-mail messages in
Choose all that apply:
[ 47.9% ] a) The patient's paper chart
[ 16.7% ] b) The patient's electronic medical record
[ 27.1% ] c) A special e-mail folder on the computer
[ 4.2% ] d) A special paper file for e-mail printouts
[ 4.2% ] e) No records like these

 

19. Do you think it is necessary to discuss the use of e-mail with patients prior to sending them messages?
Choose one:
[ 89.2% ] a) Yes
[ 10.8% ] b) No

 

20. How soon (on average) do you reply to patient-initiated messages?
Choose one:
[ 54.1% ] a) Less than 24 hours
[ 40.5% ] b) 24 to 48 hours
[ 2.7% ] c) 2 to 3 days
[ 2.7% ] d) 3 to 5 days
[ 0 % ] e) More than 5 days

 

21. Do you use an auto-reply feature that sends a confirmation of receipt of all messages to your patients?
Choose one:
[ 8.1% ] a) Yes
[ 91.9% ] b) No

 

22. How important is a security encryption system for doctor-patient e-mail messages?
Choose one:
[ 60.5% ] a) Very important
[ 23.7% ] b) Important
[ 15.8% ] c) Somewhat important
[ ] d) Not very important
[ ] e) Not at all important

 

23. How would you rate your overall satisfaction with the use of e-mail to communicate with patients?
Choose one:
[ 2.7% ] a) Completely dissatisfied
[ 5.4% ] b) Somewhat dissatisfied
[ 35.1% ] c) Neutral
[ 35.1% ] d) Somewhat satisfied
[ 21.6% ] e) Completely satisfied

 

24. How many patients do you have direct responsibility for at any one time (or are in your panel, or you are the primary care provider for, etc.)?
Choose one:
[ 65.2% ] a) 0 to 1,000
[ 13.0% ] b) 1,001 to 2,000
[ 10.9% ] c) 2,001 to 3,000
[ 6.5% ] d) 3,001 to 4,000
[ 4.3% ] e) More than 4,000

 

25. How many hours per week do you spend in the clinical setting?
Choose one:
[ 39.1% ] a) 0 to 20
[ 30.4% ] b) 21 to 40
[ 13.0% ] c) 41 to 60
[ 13.0% ] d) 61 to 80
[ 4.3% ] e) More than 80

 

26. Who do you work for?
Choose one:
[ 15.9% ] a) Self-employed / private practice
[ 11.4% ] b) Small group practice
[ 2.3% ] c) Health Maintenance Organization
[ 15.9% ] d) Community Hospital
[ 54.5% ] e) Academic Medical Center

 

27. How long have you been in practice?
Choose one:
[ 19.6% ] a) Less than 10 years
[ 52.2% ] b) 11 to 20 years
[ 26.1% ] c) 21 to 30 years
[ 2.2% ] d) 31 to 40 years
[ ] e) More than 40 years

 

28. Please enter any additional comments or thoughts you have on patient-provider e-mail.

 

Thank you for participating in this survey.

 

 

© 2000 Dean F. Sittig

dfs 5/30/00