Embracing health IT increases doctor-patient face time

Physicians probably have felt pressure from patients to offer more options for electronic communication by email, text messaging, social media or chat rooms. What doctors may not know is what patients hope to get from that communication or what technology patients prefer.

A survey, issued March 21 and conducted by Public Policy Polling and the Raleigh, N.C., public relations firm Capstrat, found that patients want to maximize their face-to-face time with physicians while using technology to minimize administrative hassles that reduce face time. But the technology preference for each patient probably will vary, depending on a patient's age, race or gender.

"Overall, what we've found from this data, and helping other health care clients, is that even in today's digital age, there are still certain relationships that need to begin in person," said Brian Hugins, account director for Capstrat. "We have a more sophisticated patient base who want to be more involved in their care and expect more from their doctors. But they're still looking for that face-to-face interaction."

Digital communication can present opportunities for doctors to improve the efficiency of general or administrative items such as scheduling, bill payments and insurance claims.

Getting those services streamlined "would allow for more efficient and more productive interaction between patient and doctor," Hugins said.

Experts say there are competitive advantages to providing patients with the digital communication they crave. The problem may be identifying the right tools that will satisfy the most patients.

The survey of 843 adults, conducted in February, found that a nurse helpline is the most preferred form of communication among patients (72%). But when it comes to electronic communication, 60% of patients said they would take advantage of email if it were offered by their physician.Only 11% of patients would use social media.

About three in four patients ages 18-29 would take advantage of email, and 43% in this age group would use social media. Among those ages 30-45, 66% would use email, but only 8% would use social media if their doctors offered it.

Data also show that Hispanics are more comfortable communicating with doctors online compared with whites and blacks. And women are more willing than men to communicate with physicians online.

How patients want information

Arash Mostaghimi, MD, who wrote a report on physician use of digital communication tools in the April 18 edition of Annals of Internal Medicine, said the issue is not so much email versus social media. It's about instant access to information by whatever method patients prefer.

"The key here should be a trend toward sharing information," said Dr. Mostaghimi, an internist at Beth Israel Deaconess Medical Center in Boston. "You want access to this stuff when, where and how you want it.

"It's really easy to get caught up in the technology of the moment, but I think the key is to step back and take a look at the overall trends. And I think the overall trend right now is ubiquitous access to information instantly."

Hugins said physicians should ask patients what type of communication they want. The Capstrat-Public Policy Polling data can provide clues, he said. For example, a heavily Hispanic population would be most likely to use online scheduling and pay bills electronically.

But getting doctors to adopt any technology may take time. Email, for example, generally is accepted across all demographics and is used by physicians in other aspects of their lives. But few doctors communicate with patients by email, despite research showing the benefits to office efficiency.

A study published online in February in the Journal of Medical Internet Research found the number of physicians who frequently communicate with patients by email remained unchanged at 2.9% between 2003 and 2008. The percentage of physicians who expressed interest in using email in the future fell from 58.4% in 2003 to 52.8% in 2008.

Experts said the same barriers (privacy and security, time constraints and lack of compensation) keeping physicians from using email are keeping them from using other e-communication tools.

Nir Menachemi, PhD, MPH, author of the study in the Journal of Medical Internet Research, said doctors are stuck in limbo. They want to provide access to patients in the format patients request. But without extra time in the day to do it and no incentive to make time, physicians have resisted adopting tools such as email.

It's not that they are averse to technology, he said. Incentive programs aimed at e-prescribing and electronic medical record use, for instance, have shown early success rates.

But most of the government health IT incentive programs are focused on high-tech systems that offer effectiveness and efficiencies in the practice, not patient-centeredness, Menachemi said. Even lower tech than email is online scheduling, and most practices aren't even doing that, he said.

As payment models shift to outcome-based compensation, physicians may not have a direct financial benefit for offering patient-centered solutions, but they will have a reason to make their time spent with patients more meaningful and productive, Dr. Mastaghimi said.

Meanwhile, technology is advancing in ways that will reduce some of the time constraints preventing physicians from adopting technology. Patient-driven systems such as portals allow patients instant access to the information and tools they want without the physician acting as a real-time intermediary.

So should physicians avoid technology until all the bugs and barriers have been addressed?

"Wait-and-see doesn't work when it comes to technology," Dr. Mostaghimi said. "The technologies will always be adapting, they will always be changing, and if you are waiting for something to become totally standard for everybody, it's unlikely for that to occur."

Physicians should at least be aware of what patients are doing and of general trends in technology and social media, he said.