In the age of electronic stethoscopes, prescriptions, and health records, just 6.7% of physicians routinely communicated with patients by e-mail in 2008, according to a survey released yesterday by the Center for Studying Health System Change (HSC).

Another 14.9% of physicians connected with patients online occasionally. Only 34.5% reported having the technology to do this in the first place.

It is not as if physicians shy away from computer screens; almost 62% of physicians routinely viewed the results of diagnostic tests online, and 32.2% wrote their prescriptions electronically, according to the study. They used e-mail to communicate with other clinicians twice as much as they did with patients.

To be sure, the HSC data are 2 years old, and technology habits change rapidly—witness the rise of the iPhone—however, a survey in June 2010 by Harris Interactive and HealthDay suggests that not much has changed online between physicians and patients since 2008. The survey showed that just 9% of Americans communicate with their physician via e-mail.

The HSC survey did not differentiate between various sorts of online channels, which include traditional, unencrypted e-mail such as Yahoo and Gmail and encrypted "secure messaging" tools, which sometimes are built into patient portals where patients can request prescription refills and view their medical record.

EHR Use, Group Size, Compensation Methods Affect E-mail Habits

The HSC report cited some familiar reasons for why physicians have largely avoided e-mail with patients:

• lack of reimbursement for time spent writing and reading e-mails,
• the potential for an increased workload,
• concerns about data privacy and security,
• concerns about medical liability, and
• uncertainty about e-mail's effect on the quality of care.

Factors associated with greater use of e-mail suggest where medicine is headed: E-mail was available for 52.8% of physicians with electronic health records (EHRs), and 29.7% of them communicated with patients that way. In general, e-mail availability and use increased in step with group size. The highest availability and use of e-mail with patients—81.4% and 50.6%, respectively—was found in group or staff-model health maintenance organizations.

How physicians were paid also made a difference. Where the technology was on hand, 25.3% of physicians who were paid a fixed salary regularly e-mailed patients compared with 17.2% of physicians not paid a fixed salary. The authors of the HSC study surmise that physicians on a fixed salary "can devote more time to activities that are not directly reimbursed."

The authors state that physician–patient e-mail may increase as an indirect result of federal efforts to promote EHRs and other forms of information technology. Chief among these efforts is the 2009 economic stimulus legislation that gives physicians 6-figure bonuses for using EHRs in a meaningful way.

Physician/patient e-mail also is seen as a key feature of the so-called medical home, a practice model favored by healthcare reformers in which physicians are paid extra for coordinating a patient's care. Such a global payment may encourage physicians to take the time to compose an e-mail message to a patient, according to the authors of the HSC study.

In contrast, private health insurers Aetna and Cigna compensate physicians on a piecemeal basis for individual e-mail encounters with patients.

Robert Lowes • Medscape Medical News © 2010 WebMD, LLC