Physicians Warm to Digital Communications With Patients

Ken Terry

June 12, 2014

Forty percent of physicians say they believe the use of digital technologies to communicate with patients can improve outcomes, and the same percentage say they have increased their use of digital tools in patient care during the past year, according to a recent Manhattan Research survey.

These digital technologies include everything from the use of patient portals and emailing and texting with patients to the prescribing of mobile health apps for self-tracking and remote patient monitoring, Monique Levy, vice president of research at Manhattan Research, told Medscape Medical News.

Jonathan Linkous, chief executive officer of the American Telemedicine Association, commented, "I think we've turned a corner in the last year or 2 among providers. They're certainly not all lined up with telemedicine. But they're realizing the benefits, and costs are significantly reduced for a lot of this technology. The years of research and demonstrations have paid off, and there's a level of comfort with using this technology that wasn't there 5 years ago."

According to Manhattan Research, more than a third of physicians have recommended mHealth apps to patients, although far fewer have "prescribed" them to patients with the expectation of seeing monitoring data. More than 20% of physicians, however, monitor patients remotely, either through home monitoring equipment or mobile apps on cellphones. And 22% of physicians now text with patients, with a 40% increase seen in the past year alone, Levy said.

Although she viewed this growth as significant, she was not sure what it meant. Perhaps some physicians are texting as "an interim solution for efficiency," she said, while they adjust to using electronic health record portals for patient communications. The survey found that nearly a quarter of physicians or their care teams communicated with patients via a portal in the past year.

Video consultations, a form of telehealth, are still relatively uncommon, with less than 10% of physicians engaging in this kind of activity, Levy said. But in a news release, James Avallone, director of physician research for Manhattan Research, said, "As we move to an outcomes-based model of healthcare provision in the U.S., remote monitoring and telehealth are going to drive an extension of the point of care."

Rules and Money

Linkous agreed. "The question is not the technology, but the payment and the regulatory systems," he said.

The fee-for-service payment system has been a stumbling block to a wider use of digital technology, noted Reid Blackwelder, MD, president of the American Academy of Family Physicians (AAFP), in an interview with Medscape Medical News. Although physicians have long used telephone and email to communicate with patients, he said, "As we move toward a pay-for-value process, that allows us to be paid for the care that we were already providing, and we're likely to do more of that [nonvisit care]."

For example, he predicted, the percentage of physicians who use remote patient monitoring is likely to increase. If they are simply trying to keep track of a patient's blood pressure or blood glucose level, he said, remote monitoring can prevent unnecessary office visits, "because this isn't something they need to see a patient for, unless there's a problem."

Dr. Blackwelder also regards telehealth as a key building block in the delivery of care going forward. Telehealth can help address access issues by increasing the availability of primary care, helping people who have difficulty getting to a physician's office, and in rural areas, providing access to subspecialty care, he said.

However, he stressed, "Our first guideline for electronic visits is that they're available only to established patients who previously received care from a physician practice." The reason: outside the context of an established relationship, it is very challenging for physicians to provide sound medical advice or treatment remotely.

Recently, the Idaho medical licensing board disciplined a family physician who had prescribed an antibiotic for a patient she had spoken with on the telephone but had never met. The physician, Ann DeJong, MD, was working for a service called Consult-a-Doctor when she was contacted by that patient.

Without commenting on DeJong's case, Dr. Blackwelder stated, "The most important component is having an established relationship with the patient. That opens the door to many opportunities to use technology and telemedicine to provide care."

A number of health plans, including WellPoint and United Healthcare, offer remote consulting services to their members. WellPoint's program, which uses videoconferencing, is available in 44 states. Dr. Blackwelder could not say whether the AAFP has a policy about such services, however, he said, "These things are accelerating, and we have to be aware of the possible benefits and the possible risks."

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