Doctor-Patient E-Mails Are a Healthy Addition, Research Shows

08 july 2010-- Patients with diabetes or hypertension or both who communicated with their doctors via e-mail got better care and better health outcomes, new California research contends.

The improvements as a result of the e-mail exchanges included such measures as blood sugar and blood pressure control, according to a report appearing in Health Affairs.

The American Recovery and Reinvestment Act of 2009 has called for implementing "secure patient-physician messaging" as part of electronic health records by 2013.

Kaiser Permanente health system started phasing in secure e-mail communication nationwide in 2004. In southern California, some three million patients as well as all primary and specialty care Kaiser doctors signed up for it and, by the end of 2008, 35,423 adult patients (7.8 percent of members in that geographical area) and 3,092 primary care physicians had actually used it.

The study authors, from Kaiser Permanente, analyzed 630,807 e-mail messages between patients and doctors from March 2006 to December 2008, then compared them to baseline data from the previous year. The vast majority of the e-mails (85 percent) were initiated by the patients.

Those who emailed their doctors saw improvements of 2.4 percent to 6.5 percent in blood sugar control and screening, cholesterol screening and control as well as screening for retinopathy and nephropathy (kidney disease).

Also, more patients with diabetes or hypertension alone achieved blood pressure levels under 140/90.

And the more frequently emails were exchanged, the greater the improvements.

According to prior studies, patients most often emailed to report some kind of change in their condition, to talk about lab results and to discuss medication issues.

Patients also tended to respect the doctor's time, with three-quarters sending messages on actual medical issues as opposed to "their mother's favorite meatloaf recipe," said Terhilda Garrido, vice president for health information technology transformation and analytics at Kaiser Permanente and senior author of the study.

"It sounds a little cliche . . . but the hypothesis [about why this works] is that putting the information in the patient's hands makes them feel empowered and, therefore, in control of their condition," Garrido added.

"A lot of our patients say this actually makes them closer or more connected to their physician, and there's information in the health literature that that kind of bonding and improved relationship is very supportive of improved health outcomes," she said.

The appeal of electronic communication is not catching on quite as quickly in the wider world, however. A recent Harris Interactive/HealthDay poll found that fewer than 1 in 10 American adults utilizes electronic medical records or turns to e-mail to contact his or her physician.

Dr. Noelle LoConte, an assistant professor of medicine at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison, who uses e-mail in her practice, said she gets "surprisingly few" e-mails each day, only five or six.

Still, for her, the system is working.

"For me, it's easier to do e-mail than to constantly be on the phone because I can decide when I'm going to open the e-mail account," LoConte said. Often, that means after the kids go to sleep and before they wake up.

As for the patients, she's heard no complaints and "they still have the phone," she said.

More information

The National Institutes of Health has more on electronic health records.