Physician Use of Email

The Center for Studying Health System Change has issued results of a survey regarding doctors’ email interactions with patients.   (CSHSC Study) The survey has many interesting tidbits.  While a majority of patients have indicated a desire to use email to communicate to physicians, most physicians do not have a capability to conduct such communication and even those who do rarely use it.  Only about 35% of US physicians report having an email capability with patients and only 20% of those, or 6.7% of all doctors, say they have used it routinely.  Twice as many physicians routinely use email to interact with other providers.

Email patient interaction has a low utilization compared to other forms of IT used by doctors.  Among 16 functionalities, it ranked last in routine use.  Lab results, for example, were available by IT for 77% of doctors and 62% routinely used it.   Doctors in practices with full EHRs were more likely to have access to email and three times more likely to use it than those who didn’t.   As might be expected, physicians in smaller practices were least likely to have access to and use email and those in group or staff model HMOs had the highest access and routine use, at 81% and 51%, respectively.  Rural doctors had lower access and use, which is particularly unfortunate given the provider access issues in those geographies.  Physicians paid a fixed salary were the heaviest users.

Primary reasons for low use of email include lack of reimbursement, creation of an increased workload, privacy and security issues, potential liability and quality of care concerns.  Since email and other forms of electronic interaction can be lower cost than in-person visits and can enhance physician productivity and patient convenience, policymakers and the overall health system should do more to facilitate their use.  Recent studies suggest no reason to have quality concerns.  As with many things in health care, implementation of a good idea just seems to take a lot longer than it should.