Electronic Healthcare Communication
Electronic healthcare communication in patient-physician interaction may facilitate better care for patients and more efficient practice for physicians.
eHealth interactions has the potential to reduce prevalent overload experience, reduce consumption of higher-cost in-person services, and strengthen physician-patient relationship through the more affordable, convenient and immediate access eHealth services encompass.
According to a recent study by the California HealthCare Foundation, up to 77% of healthcare consumers desire to interact with their physicians online (1). A 2006 Gartner study reports that over 85% of physicians are looking to streamline their operations using the internet, and 90% of providers see the internet as a way to gain a competitive advantage (2).
E-mail is the most common and accessible asynchronous electronic interaction channel, though latest interactive technologies such as digital telephony, video conferencing and healthcare 2.0 platforms continuously expand eHealth communication tracks.
As eHealth mail communication becomes more widespread, secured interactions between patients and physicians, such as follow-up inquiries, receiving data from home monitoring and accordingly adjustment of medication, will be facilitated. eHealth mail may also promote communication between providers i.e. between the primary care physician and a specialist. Speciality consultations could include an e-mail message with an encrypted attachment of a patient's test results, a secured link to the patient's archived digital radiograph or a digital photo of a skin lesion.
In a milestone article Slack presents the incomplete but encouraging underlying evidence for patient-physician communicant. The article emphasizes how eHealth communication can help physicians better incorporate into clinical practice one of the most underused resources in medicine – the patient – whose help is greatly enhanced through this new technology (3).
Major potential barriers and concerns regarding eHealth communication implementation include confidentiality and security issues, concerns regarding a deteriorating effect this remote communication module might have on patient-physician relationship, potential overloading of the physician with unnecessary electronic mail (4), and legal-malpractice questions that should be further explicitly addressed and defined as this new communication channel may expose both patients and physicians to vagueness not recognized during traditional patient-physician encounter.
Though general email communication is wildly used, eHealth mail is still under-used as was apparent in a 2002 survey, showing that only 6% of respondents reported using e-mail to contact a physician or other health care professional (5).
The American Medical Association (AMA) has released guidelines for physicians using e-mail in an attempt to standardize electronic communication. These suggestions advise establishing timely responses, discouraging e-mail communication for insistent matters, explaining electronic mail procedures to patients, and making the patients informed that e-mails can be printed or copied and inserted into standard patient records (6). Urged on by the AMA and the American College of Physicians, insurers and health plans are exploring ways of paying physicians for using email (7).
As with other healthcare IT systems, eHealth communication applications prosperity depends on an appropriate methodological and usability characterization, designing it to fit both patients needs and physicians workflow.
Clinician-Patient Electronic Messaging
More and more patients expect to be able to communicate with their doctor via email. Messaging via secure websites makes it easier to accommodate relatively sensitive clinical information this way, and has the added benefit of creating documentation in the health record- a written record in the patient’s words. Electronic messaging is asynchronous so that it can be fit into a busy clinicians day, and patients appreciate being able to spend more time formulating their questions and concerns. Electronic messaging allows links to reliable web based informational resources that can also be a source of efficiency and patient centered care.
Clinicians worry about endless, time consuming emails, but experience has shown that this is seldom an issue. In fact, email may allow physicians to answer questions with less time compared to telephone calls.
Guidelines for using e-mail are available. The American Medical Association has articulated appropriate policies, confidentiality and ethical issues in a succinct document referenced below.
Reimbursement strategies for electronic messaging remain a challenge. Some payors compensate for 0074T coding, standards and criteria are defined, but many providers remain uncomfortable distinguishing between informational messaging and billable eVisits. Electronic messaging likely provides an opportunity for more efficient and continuous provision of health care, however.
Tips for effective patient e-mails
- Assess the emotional impact of the message. An emotional topic may be better communicated in person or by phone. However, patients may also prefer the emotional distance that e-mail affords.
- Match formality with what has been established during encounters. E-mail that is more or less formal than the established relationship is disconcerting.
- "Dear" is more formal and generally acceptable.
- "Hi" is less formal.
- "Greetings" is acceptable.
- "Sincerely" is formal and may sound computer generated.
- "Regards" and "best wishes" are currently well accepted.
- Make emails easily readable: use bullets or lists, short sentences, punctuation, and white space. Do not overestimate health literacy issues - the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions (Institute of Medicine).  
- Uncoordinated Care: A Survey of Physician and Patient Experience. http://www.chcf.org/documents/hospitals/UncoordinatedCareSnapshot07.pdf Last accessed May 11, 2008.
- Gartner. 2006 Survey of Web Portal Uses and Trends in U.S. Care Delivery Organizations. Access requires subscription.
- Slack WV.A 67-year-old man who e-mails his physician. JAMA. 2004;292:2255-2261.
- Moyer CA, Stern DT, Katz SJ, et al. "We got mail". Am J Manag Care. 1999;5:1513–1522.
- Baker L, Wagner T, Singer S, et al. Use of the Internet and for health care information. JAMA 2003;289:2400–2406.
- Bovi, AM., and CEJA. Ethical Guidelines for Use of Electronic Mail Between Patients and Physicians. The American Journal of Bioethics 2003.3(3): W43-W47.
- Gottlieb S. US doctors want to be paid for email communication with patients. BMJ 2004;328;1155.
- AMA (YPS) Guidelines for Physician-Patient Electronic Communications 
- Delbanco T. Electrons in flight--e-mail between doctors and patients. N Engl J Med. 2004 Apr 22;350(17):1705-7.
- Komives EM. Clinician-patient E-mail communication: challenges for reimbursement. N C Med J. 2005 May-Jun;66(3):238-40
- Rosen P. Patient-Physican E-mail: An Opportunity to Transform Pediatric health Care Delivery. Pediatrics. 2007;120:701-706.