According to a Nielsen survey released on Wednesday by the Council of Accountable Physician Practices and the Bipartisan Policy Center, the majority of
medical providers in the United States still do not use email or text messages to communicate with their patients, despite the fact that some patients demand such communication channels.The survey results are appalling. After all, when you receive text message reminders about your upcoming credit card bill or ask your airline a question about your flight reservation via email, why can't you communicate with your doctor in the same convenient way? Why are we still using the technology of the 20th century to communicate with our doctors in the 21st century?
The answer has three sides to it: Economics, business and regulations.
Physicians have to make a living. In the current fee-for-service payment system, doctors are only paid for the services for which they can submit a claim to the insurance companies. As you may have guessed already, there is no billing code for emailing or texting patients, and thus, doctors will not be reimbursed for the time and energy that they spend on emails and text messages. If they can answer your question during an office visit (for which they get paid), why would they answer it in an unpaid email?
The shift towards value-based payment models – in which doctors are paid for the quality of their services – will change the current incentive structure for medical providers. In the new payment system, physicians will have to reduce their costs by preventing unnecessary office visits. If an email or text message will help them to keep you away from their office, then they will certainly adopt these communication technologies.
Information technology has revolutionized all industries but health care. Everyone, except doctors and hospitals, has had to either jump on the information technology bandwagon or go out of business. The lack of economic incentives in the fee-for-service payment model has prevented physicians from seriously considering implementing such technologies in their practices. Even larger medical providers rarely have a well-defined digital strategy.
As a result, while other industries now have learned how to adopt, use and manage information technology, the health care sector lacks the required business expertise for successful implementation of information technology. Even if medical providers want to better communicate with their patients, they neither have the tools nor the expertise, at least as compared with other industries.
And if these technologies are not correctly implemented and integrated with the workflow of medical providers, they will become a problem rather than a solution. Imagine, for example, a doctor who is constantly distracted by the flow of emails and text messages form his patients.
Finally, the misunderstanding of laws and regulations that intend to protect patient privacy in health care further inhibits medical providers from fully embracing IT. The Health Insurance Portability and Accountability Act, commonly known as HIPAA, is a good example. Although I believe HIPAA is a fairly well-designed act and functions rather well to protect patients' privacy, as David Harlow pointed out, there's a lot of confusion about HIPAA on the part of medical providers, and tremendous resistance to open communication in health care, even when authorized and demanded by patients.
These factors together have created a situation in which medical providers do not have the incentive to better communicate with their patients. Even if they want to do so, providers rarely know how to and are often concerned about the possible legal consequences of their actions. Given these barriers, the fact that even a small percentage of medical providers are using these communication technologies is surprising to me.
Despite the lackluster survey results, I believe that medical providers will use modern communication tools in near future. As value-based payments replace the fee-for-service models, providers will have a much greater incentive to communicate with their patients. This demand from the side of medical providers will drive the IT sector to develop the required tool, and very soon, the health care industry will learn how to successfully integrate these technologies into their daily routine. The generation of young and digitally native doctors will help expedite this process.
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