Email Reminders and Online Doctor-Patient Communications

Back in February, we posted an article on the two sides of patient-physician email communications. On one side there were the efficiencies that were possible. On the other side, there was concern that subtle clues could lead to mis-diagnosis. A comment from Yu noted that adding a nurse could help improve the quality of communications.

Recently, our friends at, a secure communications service, pointed us to a study, published in March, 2011, where online communications was used to improve the efficiency in treating depression while achieving the same result as telephone-based treatment. And indeed, there was a registered nurse inserted in the mix.

The study by a team in Group Health Research Institute, Seattle, Washington was published in 2011 but ran in 2009. In it, the investigators used a patient website that allowed patients to refill prescriptions, view laboratory results and exchange online messages with providers. Automated e-mail reminders alerted patients to new messages or laboratory results.

A nurse care manager ran the communications with the patient, which included a welcome email and scheduled monitoring contact with patients, and communicated with the treating physician. The care manager would also facilitate follow up visits, medication changes, or specialty referrals between the patient and the physician.

The study found that staff time require to provide depression follow-up was half that required for telephone programs and the outcomes were similar. The study also noted the automating more of the work of the care manager, such as welcome messages, invitation messages, reminders to those not completing assessments, could  further increase efficiency. (We’ll be publishing a customer story soon on how the Ottawa Fertility Center automated their welcome, registration, and patient educations based on Cliniconex automated emails. Stay tuned for that…)

No information on how physicians liked the online treatment system, however.

The study did note that, while surveys find that interest in email communications with health care providers is high, the likelihood of implementation of such a system is low:

Unfortunately, online health communication, whether with physician or non-physician providers, would not be reimbursed by most US health insurance systems. Even if the cost of online care management is low, implementation is unlikely without reimbursement reform.

No such billing codes exist in Canada either, as far as we’re aware. While this may affect a physician’s interest in emailing patients, this study suggests that email between staff and patients simplifies workflow and improves productivity.



Reminders in Skin Cancer Study

MedPage Today ran an article describing the results of a recently published study on the use of patient education, skin exam tutorials and electronic reminders. The results were impressive, in that patients “were more than twice as likely to perform skin self-examination and were almost three times more likely to report confidence in their ability to identify melanoma” than the control group.

MedPage Today: Digital Aids Boost Self-Exams for Melanoma

The study notes also that “telecommunication reminders also have achieved success in improving patient knowledge and modifying behaviors related to type 2 diabetes, breast health, sickle cell-associated pain, and weight loss.”

The study by Dr. Savina Aneja and Dr. Angela Brimhall, School of Medicine, Case Western Reserve University is “Improvement in patient performance of skin self-examinations after intervention with interactive education and telecommunication reminders” and available at:

60% No Show Reduction in NHS Hospital



Recently published results from the Portsmouth Hospitals in UK, where they found that automated text and voice reminders reduced no-shows by a whopping 60%: AboutMyArea – Portsmouth

The reminders program began in 2008 and immediately resulted in fewer how shows – 38%. In 2012, a spokesperson at the Portsmouth Hospital Trust said: “Now in 2012 we have managed to reduce our DNAs to just over 8% across the Trust  with an overall reduction of over 60%.”

Interesting note about workflow impact of reminder letters, which they tried first: “We began by sending out patient reminders by letter 10 days before appointments. While this was successful, it was very time consuming for the Trust.”

E-Mail Communication In Health Care: Where’s The Standard?

The debate on the use of e-mail communication between doctors and patients has been receiving a lot of attention lately. A recent WSJ article takes a look at the discussion from both sides of the fence. Dr. Kvedar, founder and director of the Center for Connected Health in Boston,  proposes that use of e-mail in the doctor’s office creates accessibility, openness, and improved communication with the patient. “I believe that patients understand the risks of email communication, and are willing to bear those risks in exchange for the more timely, useful and personal care that email can help bring about,” said Dr. Kvedar. He points out that privacy concerns are going exist with any communication system, and e-mail can be more effective than other methods at connecting with patients.

Not everyone agrees with that assessment. Dr. Bierstock,  founder and president of health-care IT consulting group Champions in Healthcare, argues that while basic patient-doctor communication might increase, there is too much risk of missing something through e-mail. “Providing care includes an ability to interpret body language, facial expressions and other silent forms of communication that allow doctors to assess patient reactions to information about their health,” Dr. Bierstock explains. “Online communications eliminate the ability to interpret these important signals.”

The argument for increased efficiency might be tempting, agrees Dr. Sadaty in his response to the WSJ article. Dr. Sadaty is a medical practitioner who at one point utilized e-mail in his practice. He stopped because he still had reservations about its overall usefulness in providing patient care. “There is an aspect of the doctor-patient interaction that that cannot be duplicated through the email process,” Dr. Sadaty explains. He describes how missed diagnoses, ineffective use of communication, and confusion all factor against perceived benefits.

Is e-mail communication, a mainstay of practically every other service provider, unfit to use as a resource between patient and doctor? Or is the solution simply increased e-mail encryption, compliant with jurisdictional privacy laws, to put doctors at ease regarding PHI and other confidential information? The issue of patient privacy & liability might be causing doctors to be more reserved about e-mail use; after all, potential lawsuits are no laughing matter.

As a company aiming to improve communication in health care, Cliniconex is focused on understanding the unique needs of both the provider and the patient. In this era of connectivity, there are unlimited possibilities when it comes to improvements in health care through communication. In order to make progress on this front, one must analyze both the pros and the cons of each communication tool  and see how they hold up against the industry’s standards.

Health Care Summit in Victoria – Premiers Discuss Evolution of Health Care Funding

“Finance Minister Jim Flaherty abruptly announced last month that Ottawa will guarantee health-care funding increases of six per cent until the 2016-17 fiscal year. After that, the annual increase will be tied to the nominal GDP, the monetary value of all goods and services produced within the country annually, including inflation. Funding increases of at least three per cent will be guaranteed.”


There has been recent controversy regarding future federal funding for provincial health care services. It is important to monitor policy changes, as they may affect how the market views privatization in health care, and we may see different provincial interpretations of what future health care delivery will look like.

A few highlights:

-The federal government  maintains that it is up to the provinces to administer health care, and thus appears unwilling to have the federal government “lead” the provinces in any innovation or reform. This leaves us with many fragmented approaches.

-At this health care summit, the idea of a future health care system that utilizes more private, for-profit health care service hasn’t been ruled out by the premiers. If the federal government wants the provinces at the helm of change, we might see different intepretations of the Canada Health Act (thus, a change in the infrastructure of health care delivery)

-There is concern that poorer provinces will end up with poorer care. As Nova Scotia Premier Darrell Dexter said, “Equal funding is not necessarily equitable funding.”

-Many premiers have expressed concern that the aging population’s cost to health care will steadily increase over the next few years. If this new round of funding is essentially a “flat rate” that doesn’t account for this growing cost, we may see a reduction in services available.

Innovation in Mobile Healthcare Apps

The market is inundated with mobile healthcare applications; there is an entire section dedicated to health care for professionals in the iPhone app store. For innovators looking to improve doctor/patient relations or patient adherence to treatment, there are a number of health portals, monitoring apps (i.e., for diabetes management), and other health information tools available to both physicians and consumers. As communication-based apps continue to expand within health care, how will the future of these apps look? Will we be seeing more patient-centric disease management tools, or more applications aimed at assisting physicians with their diagnoses, prescriptions, and up-to-date medical knowledge & breaking news? Dr. James Aw, medical director of the Medcan Clinic in Toronto, weighs in on the future of medical apps.

What Does the NHS IT Debacle Mean for Canada?

Recently, the U.K.’s centralized electronic health record program was acknowledged to have failed in its entirety and was scrapped.  Introduced in 2005, the £12 billion (about $20 billion CAD) program was created to move the U.K. health care system toward a single, centrally-mandated EHR. In what has been called the largest civilian IT project ever, the program has been criticized as being a waste of taxpayer’s money and failing in its core objectives.  With their government facing severe fiscal limits, U.K. taxpayers could no longer afford to take a “wait-and-see” approach.

To shed some light on what this means for Canada, we took at look at OECD’s data on national health expenditures and life expectancy at birth. We got the idea from The Baseline Scenario.

First of all, most of the data is relative to the OECD median life expectancy or health spending. The exception is the OECD trend, which is absolute and shows that over the period, OECD countries spent more and gained longer life expectancy. So, in absolute terms, the median is drifting upwards towards the right.

If a country stays clustered around the zero crossing for the axes (where the OECD median is), that country’s health expenditures are rising and health is improving for the population. This is the case for the U.K.  Their relative expenditures increased earlier but then drove aggressively back towards the OECD median. When money becomes tight, programs get cut. With about two-thirds of the IT program’s multi-billion dollar cost already spent and no foreseeable end in sight, the long-criticized NHS program was an easy target. The proposed alternative is to favour cheaper regional options chosen by the hospitals and GPs.


So here’s the thing for Canada. We’re in much better fiscal shape than the U.K., having escaped relatively unscathed from the latest recession. So we may be able to afford a little more time with our healthcare IT projects. Given current world economic stress, it might be inevitable that our healthcare spending will be aggressively driven back towards the OECD median.

The warning signs are there that Canada’s EHR initiatives could be likely targets. As the April 2010 Auditor General’s report points out, there have been modest advancements made, but not without significant criticism.  In what has been painted as a “dismal” picture, the initiative has taken flak for its comprehensive plans that are depicted as muddled, uncoordinated, and loosely interpreted by individual provinces.  While some provinces have seen more centralized EHR development than others (I.e. Alberta’s Netcare EHR), there is a long road ahead to reach the goal of pan-Canadian interoperability. Questions of timing, quantifiable progress, compatibility, benefits, and ultimate costs are burdening the initiative.

Infoway’s EHR effort needs to show progress and achieve stated outcomes.  And it needs to do it quickly. As U.K. health care has shown us, there isn’t time for the “wait-and-see” approach. Canada needs quantifiable results in the short-term, or the program will become a leading candidate for future budget cuts.


$72 Million eHealth Ontario Initiative

Earlier this year, eHealth Ontario announced ConnectingGTA, a pilot project to securely connect 700 service providers in the Greater Toronto Area. Connecting clinic, test lab and other systems reduces costs and improves services by creating a powerful network effect within Ontario healthcare. Patients and providers will benefit from ConnectingGTA, from better coordinated health care, more timely treatment, improved productivity, and reduced costs.

Here’s the project’s big challenge: getting this network effect kick-started. While Canadian health care is notoriously slow at adopting technology generally, there has been significant investment in systems already. This is not a green field situation, so to speak. So, not only are there technical challenges, but also a political, social and economic ones, too.

The breadth of the challenge is one of the reasons Cliniconex is excited. We’re looking forward to contributing and collaborating with Mohawk College and Coral CEA, who co-issued a press release about their intentions yesterday.

ConnectingGTA’s first phase completes in 2013.

SMS in the spotlight for Healthcare IT

The Wall Street Journal’s Technology Innovation Award (may require a subscription) winners were announced yesterday.

In the Healthcare IT category, judges picked Novartis’ SMS for Life application, which uses text messaging to track malaria supplies in remote clinics in Africa as the winner. The service is already used in Tanzania and is in pilot testing in Ghana and Kenya.

Runner up was Hewlett Packard’s mPedigree system, which uses text messaging to track malaria drugs and control pharmaceutical counterfeiting.  The service started in 2007 in Ghana.


Stock Trader Alert App Selected by Orange Business Services – Trading Solutions

“GENBAND, a leading developer of IP infrastructure and application solutions, today announced that the Cliniconex Stock Trader Alert application, which was developed as part of GENBAND’s GENFuzion™ Developer Challenge, has been selected by Orange Business Services – Trading Solutions, the leader in voice and electronic trading infrastructure and services for trading communities.”

“We look forward to presenting this innovative stock tracking solution to our customers in the financial market, ” Lionel Grosclaude, CEO, Trading Solutions.

GENBAND press release here.