Survey: Physicians Behind the Curve on Digital Communications

Alicia Ault

November 04, 2015

A new survey finds that physicians are far behind the curve when it comes to offering patients a wide variety of ways to communicate by smartphone or online — technologies that not only are a part of most people's daily lives, but that could improve efficiency and care.

The survey found that physician offices rarely offer online appointment scheduling, email communications, or text reminders, and almost half did not make use of traditional telephonic appointment reminders. Virtual care, such as telemedicine, was almost completely unavailable.

Overall, less than a third of Americans have access to digital communications with their physicians, said Jennifer Colamonico, vice president of Healthcare Insights, for Nielsen Strategic Health Perspectives, which surveyed 5000 consumers online and 626 physicians by phone in June 2015.

"Most Americans really today don't even benefit from very rudimentary virtual interactions with health care providers," said Colamonico, at a briefing held here that was cosponsored by the Washington, DC-based Bipartisan Policy Center and the Council of Accountable Physician Practices (CAPP), an affiliate of the American Medical Group Foundation that comprises medical group and health system leaders.

The results "emphasize how few patients and providers are actually using the technologies that we use in most other aspects of our daily lives," said Janet Marchibroda, director of health innovation at the Bipartisan Policy Center.

Often, health problems can't be addressed in the 9-to-5 traditional office-hour framework, said Robert Pearl, MD, chairman of the CAPP and chief executive officer of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. "Digital technologies can help overcome the barriers to accessing medical care, yet our survey shows that these tools are not available to most Americans," he said.

Gap Between Wants and Availability

The Nielsen survey shows that there was often a gap between what consumers said they wanted and their awareness of what was available. For instance, 36% said they were interested in having access to a 24/7 telephone advice line, but only 14% had used that type of service.

Twenty-six percent said they wanted to submit photos of conditions before a phone or email consultation, but only 3% had done so.

But the gap may also be due to those services not being available.

Only half of consumers surveyed said their physicians' office made calls to remind them about appointments. Twenty-eight percent said their primary physician had a portal to log on and see their health information. That was a 14% increase from the 2014 survey, which likely was a result of stage 2 meaningful use requirements, Marchibroda told Medscape Medical News.

Still, 34% of those who did not have a portal said they wanted one.

Twenty-one percent had online appointment scheduling; 36% said they'd like to have that service. A fifth had email appointment reminders and 15% could email with their physician, while another 15% said they were using an online platform to communicate. Almost a third of those without that platform said they'd like to have access to one.

For the first time, Nielsen asked if consumers had access to nontraditional avenues of care through their primary physician. Twenty-seven percent said their doctor had a nurse-manned advice line, but only 14% said it was available 24/7. Thirteen percent said their physician had evening and weekend hours, while another 37% said they wanted that service.

Evening and weekend hours were especially desired by people with children — 51% said they wanted access during those times.

People with severe chronic illness like cancer or heart disease did not fare much better — and sometimes had less access. For instance, only 10% of cancer patients and 12% of cardiac patients said their doctor had evening and weekend hours.

Only 6% of low-income consumers — most of whom rely solely on mobile communication — reported they had received text appointment reminders, compared with 9% of respondents overall. Young adults, who live their lives almost exclusively through texting, had a high awareness of the possibility of text-based reminders, but only 12% of 18-to-34-year-olds said they'd received appointment reminders, and 9% said they'd received medication or other health reminders by text. Forty-four percent of that age group said they wanted text reminders.

Physician Skepticism, Lack of Pay Are Obstacles

The survey found that physicians are skeptical that digital technologies provide value, said Colamonico.

When asked what technologies they might recommend, just 11% of physicians said email reminders, and 8% said text reminders. Only 6% said they'd use an iPad to provide health information in their office. Five percent said they'd recommend use of a mobile app to monitor physical activity levels, which was a significant increase from the previous year.

Very few physicians use digital technology that would be considered telemedicine, such as remote monitoring of vital signs, or consultations or diagnosis through video. Thirty-nine percent said they thought the technology was good for patients, but 31% said it was "not worth the hype."

A fifth each said it was not good for personal income or not good for practice revenue.

"The financial barrier is a big" obstacle, said Marchibroda.

Dr Pearl agreed, but said that physicians also need to embrace new payment models that reward value over volume, and that technology is part of the value proposition.

"We don't believe that the problems of the 21st century can be solved with the tools and the technology of the past," he said.

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