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 Helathcaremadesimple.ca, 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.