Wednesday, January 10, 2007

On-line between doctors and patients

We have a nifty program called PatientSite that allows doctors and patients to exchange information on a password protected site. Doctors can send reminder notices to patients and updates on various items. Patients can use it to make appointments, get referrals, read test results, order prescriptions, and the like. (Yes, of course, the prescription orders go directly the your favorite pharmacy in your neighborhood!)

Our theory is that a lot of communication between doctors and patients can happen on-line, asynchronously. This leaves doctors free to spend time on the telephone or in person for the things that are more urgent or require more personal attention. It also means that you, as a patient, can send in a request at whatever time suits you.

Each doctor has the ability to customize the PatientSite features provided to his or her patients -- the clinician's schedule, the patient's allergy list, lab results, medication list, microbiology reports, EKGs, pathology results, X-ray reports. Most doctors offer patients most of these features, but, for example, some doctors prefer to talk to a patient about test results rather than having them available first on line.

You wonder how much this is used? Here are some statistics for those patients who have chosen to sign up for the service.

Clinical messages from patient to provider: 25 (per 100 patients)
Number of prescription requests: 4 (per 100 patients)
Number of appointment requests: 2 (per 100 patients)
Number of referral requests: 2 (per 100 patients)

Percentage of patients seeking technical support in the use of PatientSite: 2-4%

Percentage of enrolled patients who log in each month: 35-40%
Of those who logged in:
  • Percentage of patients who looked at lab results: 31%
  • Percentage of patients who looked at X-ray results: 20%
  • Percent of patients who reviewed medications: 24%

Try the demo! I think you will be impressed.

13 comments:

Maxine said...

I love the PatientSite. Not only can I request and check appointments and get prescription refills, but I can check x-ray reports and test results faster than waiting to hear from my doctor. This enables me to have questions for discussion ready when I hear from her. I can also email her with questions.
There are also links to lots of helpful information.

Patient Dave said...

I too love it.

I think it's important to understand the email feature. It's not ordinary email that comes and goes through your regular email program. Many doctors have regular email accounts, but regular email is not at all secure. It's easily eavesdropped by snoopers, so if you're at all concerned about privacy, it would be completely unacceptable to send confidential info by regular email.

With PatientSite you get a little email that says "You have a message - click here." It takes you to your PatientSite login screen, and then you read & write messages *while inside their system,* using the same SSL security methods that banks use.

Separately, I was tickled the first time the doc upped my BP medication and transmitted it to the Walgreen's near my house. This is so modern, cost-effective, and time-saving, it's just silly to do it the old-fashioned way.

It's little bumpy in spots, figuring out where to find everything, but their support people actually respond to my questions. It works very well.

BC said...

It looks like a great tool for the patient. It seems, though, that the constraint is the doctor's time. How much time does it typically take per week or per month for the doc to read and respond to patient inquiries? How many of the requests (appointments, etc.) could be handled by staff? Is the doctor or staff time spent responding to patients billable? If so, how does that work? Does the doctor usually schedule less office appointment time than previously to free up time for e-mail work?

Paul Levy said...

BC,

I will see if I can get some doctors to reply directly to your questions.

david ives said...

bc - because patientsite offers doctors the opportunity to handle patient query asynchronously is dramatically improves the efficiency of the office. In addition, messages can/are also sent straight to staff, for example, requesting an appointment or referral. i don't know how I could practice without it !

Anonymous said...

BC et al.,

I'm a responding doc. Thanks for the comments and for anticipating and appreciating some of the concerns of providers using PatientSite. Paul captures our excitement and the "niftiness" of PatientSite well in his initial post. I'm one of the primary care docs at BIDMC and the medical director of HCA, the hospital-based primary care practice. I do a lot of administration and teaching but I also have a busy practice and use PatientSite with many of my patients. Happily, the message traffic for me has been very reasonable in both the quantity and quality of postings from patients. We emphasize that this is not to be used for urgent issues and ask patients to call to speak with one of our triage nurses for active clinical symptoms, etc. To my mind, the email communication part of PatientSite is best for issues that require thought and discussion on a timeline of several days. In my experience, this takes the place of phone tag, although some of the messages I receive engender a call back from me as a direct interaction is often better. I have learned important things from PatientSite messages that patients would not have called me about.
I would love to say that I log on to PatientSite daily but the demands on my time are such that I usually respond to PatientSite messages several days a week. There are occasional errant messages that should go to others -- schedulers, prescription staff --but these are rare and when routed correctly are generally serviced within a day or two of the request. One insurer in Boston allows reimbursement for phone consultation when one fulfills certain criteria; we don't try to bill for PatientSite contacts. It is true that the level of potential connectedness these days has the potential to create a lot of entropy. Phone calls, pages, PatientSite messages, huge piles of paper -- all besiege physicians on a daily basis and this deluge has outpaced our ability to respond or even to establish reasonable standards of responsiveness. A patient calling in or emailing has no idea if I am in a practice session seeing patients or teaching a course or whatever. Happily, patients using PatientSite seem to understand that this is asynchonous; I will often post a reply at 11 PM. There's much more to say, but I'll close and leave time for others to chime in....

JJH

Patient X said...

I use the PatientSite. You mentioned that you can check test results. For some reason, this has been disabled and I no longer have access to any lab or other reports. I spoke to my MD about this and she said it was universal. But it seems like others can still view these. Hmmm...

Paul Levy said...

No, it is up to each doctor.

Daniel said...

I am a primary care doc at BIDMC and have used email with patients for a long time. When I first started, I did have concerns that patients might use emails in problematic ways (email about emergencies, email very frequently, send 1000 word emails). Happily, this really hasn't been the case. I still get more email via my regular email account than PatientSite (because I have given out my email address to patients liberally), but I am thinking of trying to migrate all patient email to PatientSite. As patient dave points out, PatientSite is significantly more secure/private. Additionally, I have started to see some of my patient email filtered out by the spam filter in my regular email (there doesn't need to be filter in PatientSite because of how it works), particularly if patients are asking for medication refills (especially if it's regarding a Viagra refill!).

My one piece of advise to patients is that you should send your email again if you don't get a response in a reasonable time frame (I think 24-48 hours is reasonable). It's not that the doctor is ignoring you, it's just that there are so many demands on our time that it's easy for your email to slide far enough down the queue that it gets lost.

To address patient X's comment, your own doctor determines what you can see - access to labs or xrays or notes can be turned on or off. I think some docs fear that they will be bombarded with questions about minor (& unimportant) abnormalities in lab tests, or confusing/concerning wording on radiology reports. I have to say I am surprised how few messages or calls I get of this sort. Indeed, I sometimes wonder if many of my patients are even looking at their results, althought the stats Paul put in this post suggest that many of them are frequently logging on (btw, doctors aren't notified about patients logging on. I obviously know if someone is using patientsite if they email me, but otherwise I don't).

BC said...

I'm glad to hear the system is working so well for both patients and doctors. I find it very encouraging to learn that patients are capable of using a system like this responsibly.

Keep up the good work.

linda mcmanama said...

It is encouraging to hear about such a system - particularly to see the stats on how patients are using it. I would have expected to see more prescription, appointment and referral requests. It will be interesting to track over time to see if these increase once patients are more comfortable with the system. Approx. what percent of total patients are now using the system?

As a patient of a Hallmark Health pcp, I would love to see such a program. I do find my docs automated referral and e-prescribing capability to be helpful, although we do play phone tag. Walgreen's automatic phone refill system is also very easy to use and efficient. Do you know of other health systems with similar programs? Is it part of an electronic health record system?

Paul Levy said...

Linda,

Sorry, I am not familiar with what other systems are offering.

As far as the percentage of our patients who use the system, I am sorry but that is proprietary, competitively sensitive information that I would rather not give out.

naomi said...

I really like this. One of my good friends is moving to CO to head up expansions in the pediactric department of a major hospital out that way. I don't know if he has been exposed to a program such as this, but I can so many benefits for both patients and doctors alike.