It seems like e-mail between all patients and their physicians is no longer an “if” but a “when.” When will all patients who want this type of communication be able to use it? What is holding back e-mail communication between patients and physicians? Perhaps my own experience a few years ago can help explain it. 
My husband used to go to what could be considered a more old-fashioned practice because that’s where his preferred doctor worked. He could not e-mail for appointments, test results or medical advice. He had to call a central phone number, push a number of prompts, wait (sometimes several minutes) and often be put on hold. When he had blood tests, he would wait more than a week to get results by regular mail.
The practice to which I used to belong used a technology platform called EPIC (50% of patients in the U.S. have an EPIC medical record somewhere). All of my physicians had e-mail, and I used e-mail to ask for clarification of test results, to get advice about medication and simply to update my physician about an ongoing medical concern.
I also used the portal to request appointments, renew prescriptions and view test results (which were often in my inbox by the time I came home from the lab). The e-mail program was free to me, and my clinician’s response time was nothing short of amazing.
I understand that there are real barriers to the use of e-mail with physicians. When e-mail was first offered by my medical group, uptake by patients was somewhat slow, partly because there was a financial charge associated with it.
When the group began offering free access, however, e-mail use surged from 3,000 messages per week to 15,000 messages per week. Some physicians received 3 or 4 e-mails a day, others up to 30. Many physicians spent 30 to 60 minutes a day answering e-mail, and the average turnaround time dropped to less than 3 hours, with 92% of messages answered within 1 business day.
What created this change? Were the physicians dismayed by the increased e-mails? Not at all. The group offered tools to help physicians and patients use e-mail appropriately, and there was modest reimbursement to physicians who participated, as well as better evaluations. Many physicians found it more efficient than playing phone tag with patients, although phone traffic did not decrease because of e-mail.
Not all physicians support the use of e-mail, however, and there are good reasons for the reluctance. It takes time to read and answer e-mails adequately. Physicians also have to spend time educating patients about how to use e-mail appropriately. If physicians are not reimbursed for their e-mail time, the process can feel burdensome.
Other barriers reported by physicians include concerns about the privacy and security of e-mail communication and fear of medical liability. Physicians who practice alone or in small groups may not have the financial resources to set up an interactive system or may simply prefer communicating with patients by phone or in person.
Even taking into account the barriers, there is no doubt that e-mail communication is here to stay. Once patients have access to their own medical information in the privacy of their own homes, can contact their doctors without waiting endlessly on hold, can ask for prescription refills in an instant, and can ask questions directly of their doctors, the only remaining questions will be “how fast” and “how soon”? Fortunately, there are helpful lessons from the early adopters to guide the way.
An earlier version of this post was published in: http://www.acpinternist.org/archives/2013/11/patients.htm