An e-visit primer

The AMA has developed a brochure to give guidance to member physicians interested in offering electronic consults.

Posted Nov. 13, 2006.

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Consumer demand for convenient service has brought electronic transactions into almost every aspect of daily living. Banking can be handled online. Bills can be paid with the click of a mouse. And shopping via computer-- whether for groceries, clothes, books or just about any other product available in stores -- is now routine for millions of Americans.

Now many consumers are looking for the same convenience when it comes to communicating with their physicians. For doctors who want to delve into electronic communication or who already have done so but would like some advice, the American Medical Association has published a new brochure offering guidance.

Patient demand is out there. A September Wall Street Journal Online/Harris Interactive poll found that 74% of respondents would like to use e-mail to communicate directly with their physicians. About 67% would like to get diagnostic test results via e-mail, according to the online survey of 2,600 American adults.

Physicians who invest in information technology could give themselves a competitive advantage, the poll found. Sixty-two percent of respondents said the use of e-mail would influence their choice of doctor.

But studies show that physician practices are not keeping up with consumers' desires. For example, just 8% of respondents to the Harris poll said they either communicate directly with their doctors via e-mail or could but don't do so.

Meanwhile, 24% of respondents to a 2004-05 telephone survey of 6,600 physicians by the Center for Studying Health System Change reported that they use e-mail or a secure online tool to communicate clinical issues with patients.

The reason for the low numbers of physicians embracing online consultation are many -- from cost issues to a widespread lack of reimbursement.

Plus, communicating with patients electronically is not as easy as shooting an e-mail to a friend. Many considerations must be weighed. A new brochure prepared for AMA members, and itself available online, explains the basics of how online consultations work. First of all, e-visits are reserved for existing patients and for nonurgent conditions. Online consults are meant to supplement, not supplant, face-to-face care.

Doctors start by checking state laws to make sure that special licensing is not necessary. Then they contract with a company that connects physicians and patients through a secure messaging system. One such company is Medem, which is partially owned by the AMA; among others is RelayHealth. Doctors pay an annual fee. Typically the vendor does not charge patients.

The patient submits his or her credit card and health insurance information for billing purposes to the vendor. The physician sets charge, service and privacy policies to which the patient must agree before e-visits can begin.

The types of services doctors can offer vary, from appointment scheduling and prescription refills to communicating test results or discussing other sensitive subject matter.

During the e-consultation, the patient enters his or her chief complaint, symptoms, questions and concerns in the computer and forwards them to the physician. As in an in-person visit, the doctor checks the patient's chart and provides an appropriate response.

Doctors must contact the health plans with which they contract to determine if they cover e-consults and what they pay for these services. The AMA has established a CPT code -- 0074T -- for online evaluation and management services.

Although many plans don't cover e-visits, a growing number are starting to experiment with them. For example, earlier this year Aetna announced that it would cover online consults for its members in California and Florida, and Cigna said it would begin covering e-visits for some businesses, including Cisco Systems.

E-consulting clearly is still in its infancy, but patient demand for fast, convenient service will fuel its growth. For doctors interested in making e-visits a part of their practice, help is out there.

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External links

AMA brochure, "Online medical consultations: Connecting physicians with patients," in pdf, members-only (link)

AMA Private Sector Advocacy (link)

Center for Studying Health System Change data bulletin, "Physicians Slow to Adopt Patient E-mail" (link)

Summary results from Wall Street Journal Online/Harris Interactive poll on Internet-based communication with patients (link)

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