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Disease Management & Health Outcomes

, Volume 15, Issue 4, pp 207–214 | Cite as

Physician-Patient e-Visit Programs

Implementation and Appropriateness
  • Pamela Whitten
  • Lorraine Buis
  • Brad Love
Current Opinion

Abstract

Telemedicine and e-health includes the delivery of healthcare over a distance through the use of telecommunication technologies. One specific application is the use of ‘e-visits’ within a clinical setting. e-Visits refer to any type of online patient-provider consultation where electronic information is exchanged, particularly involving the transmission via secure servers. Among many others, services such as patient portals and patientprovider e-mail systems fall into this category.

Research has shown that patients have a great desire for the ability to communicate with their providers electronically. Despite consumer demand, provider adoption of e-visit technologies has been slow. Though there are many applications currently being piloted across the US, universal diffusion of e-visit technology has not been reached. Reasons for provider hesitation to adopt e-visit technologies include fears of being overburdened by electronic communication, improper use of electronic communication by patients, lack of reimbursement schemes, legal and regulatory issues, and concerns over security, privacy, and confidentiality.

Further research is needed to evaluate and document a wide range of key issues regarding e-visits; evidence concerning the impacts on clinical outcomes, access to healthcare, organizational issues, and financial aspects will all be necessary to guide decision making. While it is imperative that research regarding e-visits assesses the impact on providers and patients (at a micro level), it is also essential that it assesses the organizational issues (at a macro level) that are affected by these technologies. Finally, future research should also attempt to more fully understand the financial impacts that e-visit technologies currently have and potentially could have on the healthcare industry. Market forces have historically shown the ability to alter industry structures over time, as demand and need for services increases. As a result, consumers may ultimately drive demand for e-visit services in ways providers will be required to adopt.

Keywords

Electronic Communication Organizational Issue Personal Health Information Prescription Refill Patient Portal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

References

  1. 1.
    Rasmusson K, Hartshorn J. A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic. Epilepsia 2005 May; 46(5): 614–5CrossRefGoogle Scholar
  2. 2.
    Bynum A, Cranford C, Irwin C, et al. Effect of telemedicine on patientss’ diagnosis and treatment. J Telemed Telecare 2006; 13(1): 39–43CrossRefGoogle Scholar
  3. 3.
    Kumar S, Tay-Kearney M, Chaves F, et al. Remote ophthalmology services: cost comparison of telemedicine and alternative service delivery options. J Telemed Telecare 2006; 13(1): 19–22CrossRefGoogle Scholar
  4. 4.
    Nesbitt T, Cole S, Pellegrino L, et al. Rural outreach in home telehealth: assessing challenges and reviewing successes. Telemed J E Health 2006 Apr; 12(2): 107–13PubMedCrossRefGoogle Scholar
  5. 5.
    Ellish N, Steidl S. Teleophthalmology in an urban shopping mall. Telehealth Pract Rep 2004 Sep–Oct; 9(4): 1–8Google Scholar
  6. 6.
    McConnochie KM, Wood NE, Kitzman HJ, et al. Telemedicine reduces absence resulting in illness in urban child care: evaluation of an innovation. Pediatrics 2005 May; 115(5): 1273–82PubMedCrossRefGoogle Scholar
  7. 7.
    McKoy K, DiGregorio S, Stira L. Asynchronous teledermatology in an urban primary care practice. Telemed J E Health 2004; 10 Suppl. 2: S70–80Google Scholar
  8. 8.
    Baruffaldi F, Gualdrini G, Toni A. Comparison of asynchronous and realtime teleconsulting for orthopaedic second opinions. J Telemed Telecare 2002; 8(5): 297–301PubMedCrossRefGoogle Scholar
  9. 9.
    Wilson E. Asynchronous health care communication. Commun ACM 2003 Jun; 46(6): 79CrossRefGoogle Scholar
  10. 10.
    Anderson JG, Rainey MR, Eysenbach G. The impact of cyberhealthcare on the physician-patient relationship. J Med Syst 2003; 27(1): 67–84PubMedCrossRefGoogle Scholar
  11. 11.
    Allert S, Bottcher F, Volke C, et al. E-mail in plastic surgery: a useful supplement of communication? Handchir Mikrochir Plast Chir 2001 Jan; 33(1): 65–70PubMedCrossRefGoogle Scholar
  12. 12.
    Weingart S, Rind D, Tofias Z, et al. Who uses the patient Internet portal? The PatientSite experience. J Am Med Inform Assoc 2005 Oct 12; 13: 91–5PubMedCrossRefGoogle Scholar
  13. 13.
    Leong S, Gingrich D, Lewis P, et al. Enhancing doctor-patient communication using email: a pilot study. J Am Board Fam Pract 2005 May–Jun; 18(3): 180–88PubMedCrossRefGoogle Scholar
  14. 14.
    Nguyen HQ, Carrieri-Kohlman V, Rankin SH, et al. Supporting cardiac recovery through ehealth technology. J Cardiovasc Nurs 2004 May–Jun; 19(3): 200–08PubMedGoogle Scholar
  15. 15.
    Linden W, Stossel C, Maurice J. Psychosocial interventions for patients with coronary artery disease: a meta-analysis. Arch Intern Med 1996 Apr 8; 156: 745–52PubMedCrossRefGoogle Scholar
  16. 16.
    LaCoursiere S. A theory of online social support. ANS Adv Nurs Sci 2001 Sep; 24: 60–77PubMedGoogle Scholar
  17. 17.
    Kukafka K, Gibson N, Willan A. Web-based tailoring and its effect on selfefficacy: results from the MI-HEART randomized control trials. Proc AMIA Symp 2002: 410–14Google Scholar
  18. 18.
    Brennan P. Customized computer home support improves recovery of CABG patients. Anaheim (CA): American Heart Association, 2001Google Scholar
  19. 19.
    Biermann J, Golladay G, Peterson R. Using the Internet to enhance physicianpatient communication. J Am Acad Orthop Surg 2006 Mar; 14(3): 136–44PubMedGoogle Scholar
  20. 20.
    Harris Interactive. Cyberchrondriacs update: 2002 Aug 1 [online]. Available from URL: http://www.harrisinteractive.com/harris_poll/index.asp?.PID=686 [Accessed 2006 Sep 21]
  21. 21.
    Ziebland S, Chapple A, Dumelow C, et al. How the Internet affects patientss’ experience of cancer: a qualitative study. BMJ 2004 Mar 6; 328(7439): 564PubMedCrossRefGoogle Scholar
  22. 22.
    Madden M. Internet penetration and impact: 2006 Apr 26 [online]. Available from URL: http://www.pewinternet.org/PPF/r/182/report_display.asp [Accessed 2006 Sep 19]
  23. 23.
    Horrigan J, Rainie L. The Internet’s growing role in life’s major moments [online]. Available from URL: http://www.pewinternet.org/pdfs/PIP_Major%20Moments_2006.pdf [Accessed 2006 Aug 25]
  24. 24.
    Madden M, Fox S. Finding answers online in sickness and in health. Pew Internet & American Life Project: report 2006 May 2 [online]. Available from URL: http://www.pewinternet.org/PPF/r/183/report_display.asp [Accessed 2006 Sep 19]
  25. 25.
    Slack W. A 67-year-old man who e-mails his physician. JAMA 2004; 292: 2255–61PubMedCrossRefGoogle Scholar
  26. 26.
    Anand S, Feldman M, Geller D, et al. A content analysis of e-mail communication between primary care providers and parents. Pediatrics 2005 May; 115(5): 1283–8PubMedCrossRefGoogle Scholar
  27. 27.
    Hobbs J, Wald J, Jagannath Y, et al. Opportunities to enhance patient and physician e-mail contact. Int J Med Inform 2003 Apr; 70(1): 1–9PubMedCrossRefGoogle Scholar
  28. 28.
    Audet AM, Doty MM, Peugh J, et al. Information technologies: when will they make it into physicianss’ black bags? MedGenMed 2004; 6(4): 2PubMedGoogle Scholar
  29. 29.
    Brooks RG, Menachemi N. Physicianss’ use of e-mail with patients: factors influencing electronic communication and adherence to best practices. J Med Internet Res 2006; 8(1): e2PubMedCrossRefGoogle Scholar
  30. 30.
    Kittler AF, Carlson GL, Harris C, et al. Primary care physician attitudes toward using a secure web-based portal designed to facilitate electronic communication with patients. Inform Prim Care 2004; 12(3): 129–38PubMedGoogle Scholar
  31. 31.
    Kleiner KD, Akers R, Burke BL, et al. Parent and physician attitudes regarding electronic communication in pediatric practices. Pediatrics 2002; 109(5): 740–4PubMedCrossRefGoogle Scholar
  32. 32.
    Spielberg A. On call and online: sociohistorical, legal, and ethical implications of e-mail for the patient-physician relationship. JAMA 1998; 280: 1353–9PubMedCrossRefGoogle Scholar
  33. 33.
    Quitero Simao C. A study on Internet impact in business designs for the health sector. Lisbon: Universidad Tecnica de Lisboa, 2001Google Scholar
  34. 34.
    Safran C, Goldberg H. Electronic patient records and the impact of the Internet. Int J Med Inform 2000 Nov; 60(2): 77–83PubMedCrossRefGoogle Scholar
  35. 35.
    Firth L, Francis P, Mellor D. Online medical applications malaise. In: Proceedings of the 14th annual International Telecommunications Society’s European Regional Conference; 2003 Aug 23–24; Helsinki. Helsinki: International Telecommunications Society, 2003: 14 [online]. Available from URL: http://userpage.fhw-berlin.de/~jmueller/its/conf/helsinki03/papers/Firth.pdf [Accessed 2007 Jun 12]Google Scholar
  36. 36.
    Whitten P, Kuwahara E. Telemedicine from the payor perspective: considerations for reimbursement decisions. Dis Manage Health Outcomes 2003; 11(5): 291–8CrossRefGoogle Scholar
  37. 37.
    Bleich H, Beckley R, Horowitz G, et al. Clinical computing in a teaching hospital. N Engl J Med 1985 Mar 21; 312(12): 756–64PubMedCrossRefGoogle Scholar
  38. 38.
    Safran C, Slack W, Bleich H. Role of computing in patient care in two hospitals. MD Comput 1989; 6: 141–8PubMedGoogle Scholar
  39. 39.
    Baldwin G. The connected patient. HealthLeaders, 2006 Sep [online]. Available from URL: http://www.healthleadersmedia.com/magazine/viewmagfeature/content/83307.html [Accessed 2007 Jun 3]
  40. 40.
    Angell D. Henry Ford Health System launches online doctor visits [press release] 2006 Aug 10 [online]. Available from URL: http://henryford.com/body.cfm?.id=46335&action=detail&ref=607 [Accessed 2006 Sep 20]
  41. 41.
    Houston TK, Sands DZ, Jenckes MW, et al. Experiences of patients who were early adopters of electronic communication with their physician: satisfaction, benefits, and concerns. Am J Manag Care 2004; 10(9): 601–8PubMedGoogle Scholar
  42. 42.
    Prescott B. A new generation of ‘Patientsite’ provides improved electronic communications for patients and doctors. Press release: 2002 Feb 21 [online]. Available from URL: http://www.bidmc.harvard.edu/sites/bidmc/search.asp [Accessed 2006 Sep 20]
  43. 43.
    Safran C, Rind D, Citroen M, et al. Protection of confidentiality in the computerbased patient record. MD Comput 1995 May–Jun; 12(3): 187–92PubMedGoogle Scholar
  44. 44.
    Raths D. With consumers becoming more responsible for their healthcare choices, portals can help separate tech-savvy providers and payers from the competition. Healthcare Informatics 2006 Apr [online]. Available from URL: http://healthcare-informatics.com/issues/2006/04/30/ [Accessed 2006 Sep 25]
  45. 45.
    Kaiser Permanente. Your health record: 2006 [online]. Available from URL: https://www.kaiserpermanente.org/ [Accessed 2006 Sep 20]
  46. 46.
    United States Department of Veterans Affairs. About my HealtheVet: 2006 [online]. Available from URL: http://www.myhealthyvet.va.gov/ [Accessed 2006 Sep 20]
  47. 47.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press, 2001Google Scholar
  48. 48.
    Moyer C, Stern D, Dobias K, et al. Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. Am J Manag Care 2002; 8: 427–33PubMedGoogle Scholar
  49. 49.
    Patt M, Houston T, Jenckes M, et al. Doctors who are using e-mail with their patients: a qualitative exploration. J Med Internet Res 2003 Apr–Jun; 5(2): e9PubMedCrossRefGoogle Scholar
  50. 50.
    Virji A, Yarnall K, Krause K, et al. Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication. BMC Med 2006 Aug 15; 4: 18PubMedCrossRefGoogle Scholar
  51. 51.
    Car J, Sheikh A. E-mail consultations in health care: scope and effectiveness. BMJ 2004; 329(7463): 435–8PubMedCrossRefGoogle Scholar
  52. 52.
    Neill R, Mainous A, Clark J, et al. The utility of electronic mail as a medium for patient physician communication. Arch Fam Med 1994; 3: 268–71PubMedCrossRefGoogle Scholar
  53. 53.
    Bower P, Roland M, Campbell J, et al. Setting standards based on patientss’ views on access and continuity: secondary analysis of data from the general practice assessment survey. BMJ 2003 Feb 1; 326(7383): 258PubMedCrossRefGoogle Scholar
  54. 54.
    Stevenson K, Ion V, Merry M, et al. Primary care: more than words. Health Serv J 2003 Jan 16; 113: 26–8PubMedGoogle Scholar
  55. 55.
    Ostbye T, Yarnall KSH, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005; 3(3): 209–14PubMedCrossRefGoogle Scholar
  56. 56.
    Yarnall KSH, Pollak KI, Ostbye T, et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93(4): 635–41PubMedCrossRefGoogle Scholar
  57. 57.
    Lewers D. Guidelines for patient-physician electronic mail: 2000 [online]. Available from URL: http://www.ama-assn.org/meetings/public/annual00/reports/bot/bot2a00.rtf [Accessed 2006 Sep 21]
  58. 58.
    Couchman G, Forjuoh S, Rascoe T. E-mail communications in family practice: what do patients expect? J Fam Pract 2001; 50: 414–8PubMedGoogle Scholar
  59. 59.
    Bergmo TS, Kummervold PE, Gammon D, et al. Electronic patient-provider communication: will it offset office visits and telephone consultations in primary care? Int J Med Inform 2005; 74(9): 705–10PubMedCrossRefGoogle Scholar
  60. 60.
    Ferguson T. A guided tour of self-help cyberspace: 1996 [online]. Available from URL: http://odphp.osophs.dhhs.gov/confrnce/partnr96/summary.htm [Accessed 2007 Jun 3]
  61. 61.
    Mechanic D. How should hamsters run? Some observations about sufficient patient time in primary care. BMJ 2001; 323: 266–8PubMedCrossRefGoogle Scholar
  62. 62.
    Meyer M. Physician use of e-mail: the telephone of the 21st century? J Med Pract Manage 2004; 19(5): 247–51PubMedGoogle Scholar
  63. 63.
    Yager J. E-mail therapy for anorexia nervosa: prospects and limitations. Eur Eat Disord Rev 2003 May–Jun; 11(3): 198–209CrossRefGoogle Scholar
  64. 64.
    Lin CT, Wittevrongel L, Moore L, et al. An Internet-based patient-provider communication system: randomized controlled trial. J Med Internet Res 2005; 7(4): e47PubMedCrossRefGoogle Scholar
  65. 65.
    Katz SJ, Moyer CA, Cox DT, et al. Effect of a triage-based e-mail system on clinic resource use and patient and physician satisfaction in primary care: a randomized controlled trial. J Gen Intern Med 2003; 18(9): 736–44PubMedCrossRefGoogle Scholar
  66. 66.
    Kia KF, Tavakkoli A, Ellis CN. Clinical e-mail in an academic dermatology setting. J Am Acad Dermatol 2006; 54(6): 1019–24PubMedCrossRefGoogle Scholar
  67. 67.
    Sittig DF. Results of a content analysis of electronic messages (e-mail) sent between patients and their physicians. BMC Med Inform Decis Mak 2003 Oct 1; 3: 11PubMedCrossRefGoogle Scholar
  68. 68.
    White CB, Moyer CA, Stern DT, et al. A content analysis of e-mail communication between patients and their providers: patients get the message. J Am Med Inform Assoc 2004; 11(4): 260–7PubMedCrossRefGoogle Scholar
  69. 69.
    Kassirer J. Patients, physicians, and the Internet. Health Aff 2000; 19: 115–23CrossRefGoogle Scholar
  70. 70.
    Hodge JG, Gostin LO, Jacobson PD. Legal issues concerning electronic health information: privacy, quality, and liability. JAMA 1999; 282(15): 1466–71PubMedCrossRefGoogle Scholar
  71. 71.
    Person DA. Telemedicine healthcare for Pacific Islanders: a positive return on investment [abstract]. Telemed J E Health 2002; 8(2): 208Google Scholar
  72. 72.
    Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med 2003 Apr; 114(5): 397–03PubMedCrossRefGoogle Scholar
  73. 73.
    Bell J, Patel B, Malasanos T. Knowledge improvement with web-based diabetes education program: brainfood. Diabetes Technol Ther 2006; 8(4): 444–8PubMedCrossRefGoogle Scholar
  74. 74.
    Emiliani PL. Toward an information society for all: challenges in health telematics. Stud Health Technol Inform 2000 Jan: 108–15Google Scholar
  75. 75.
    Valero MA, Arredondo MT, Guillen S, et al. Impact of a broadband interactive televisit/teleconsultation service for residential and working environments. Proc AMIA Symp 2001: 721–25Google Scholar
  76. 76.
    Katzen C, Solan MJ, Dicker AP. E-mail and oncology: a survey of radiation oncology patients and their attitudes to a new generation of health communication. Prostate Cancer Prostatic Dis 2005; 8(2): 189–93PubMedCrossRefGoogle Scholar
  77. 77.
    Kane B, Sands D. Guidelines for the clinical use of electronic mail with patients. J Am Med Inform Assoc 1998; 5: 1–15CrossRefGoogle Scholar
  78. 78.
    Bergeron B. E-mail: a realistic conduit for patient/doctor communications? J Med Pract Manage 2000; 15: 208–10PubMedGoogle Scholar
  79. 79.
    Engstrom P. Can you afford not to travel the Internet? Med Econ 1996; 73: 172–4, 176, 181PubMedGoogle Scholar
  80. 80.
    Tann J, Platts A, Welch S, et al. Patient power? Medical perspectives on patient use of the Internet. Prometheus 2003; 21(1): 145–60CrossRefGoogle Scholar
  81. 81.
    Deloitte Research and Cyber Dialogue. Taking the pulse: physicians and the Internet. New York: Deloitte Research, 2001Google Scholar
  82. 82.
    Miller E. The technical and interpersonal aspects of telemedicine: effects on doctor-patient communication. J Telemed Telecare 2003; 9(1): 1–7PubMedCrossRefGoogle Scholar
  83. 83.
    Johnston D, Westfall Bates D, Pan E, et al. The value of computerized provider order entry in ambulatory settings. Boston (MA): Center for Information Technology Leadership, HIMSS, 2003Google Scholar
  84. 84.
    Berland G, Elliott M, Morales L, et al. Health information on the internet: accessibility, quality, and readability in English and Spanish. JAMA 2001; 285: 2612–21PubMedCrossRefGoogle Scholar
  85. 85.
    Hersh W. Health care information technology: progress and barriers. JAMA 2004 Nov 10; 292(18): 2273–4PubMedCrossRefGoogle Scholar
  86. 86.
    Walker J, Pan E, Johnston D, et al. The value of health care information exchange and interoperability [online]. Health Aff 2005 Jan 19. Available from URL: http://www.content.healthaffairs.org/cgi/content/full/hlthaff.w5.10/DC1 [Accessed 2006 Sep 20]
  87. 87.
    Sittig D, King S, Hazlehurst B. A survey of patient-provider e-mail communication: what do patients think? Int J Med Inform 2001; 61: 71–80PubMedCrossRefGoogle Scholar
  88. 88.
    Liederman EM, Lee JC, Baquero VH, et al. Patient-physician web messaging: the impact on message volume and satisfaction. J Gen Intern Med 2005; 20(1): 52–7PubMedCrossRefGoogle Scholar
  89. 89.
    American College of Physicians. The changing face of ambulatory medicinereimbursing physicians for computer-based care: ACP analysis and recommendations to assure fair reimbursement for physician care rendered online. Philadelphia (PA): American College of Physicians, 2003Google Scholar
  90. 90.
    Bureau UC. Income, poverty, and health insurance coverage in the United States: 2005 [online]. Available from URL: http://www.census.gov/prod/2006pubs/p60-231.pdf [Accessed 2006 Aug 29]
  91. 91.
    Whitten P, Steinfield C, Buis L. The state of ecommerce in health: an examination, diagnosis, and prognosis. In: Murero M, Rice R, editors. The internet and health care: an international perspective. Mahwah (NJ): Lawrence Erlbaum Associates, 2006: 67–82Google Scholar
  92. 92.
    Use of e-mail raises many HIPAA concerns for EDs. ED Manag 2005; 17 (4): 42–4Google Scholar
  93. 93.
    Do your e-mails comply with new security regs? Healthcare Benchmarks Qual Improv 2005; 12 (5): 54–6Google Scholar
  94. 94.
    Are you breaking patient privacy regs with e-mails? Hosp Peer Rev 2005; 30 (5): 71–2Google Scholar
  95. 95.
    Hamit F. Interventional informatics: new paradigm for telemedicine, new market for imaging. Adv Imaging 1999 Oct; 14(10): 12–4Google Scholar
  96. 96.
    Darkins AW, Carey MA. Telemedicine and telehealth: principles, policies, performance and pitfalls. New York: Springer, 2000Google Scholar

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Authors and Affiliations

  1. 1.Michigan State UniversityEast LansingUSA

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