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.