The Emerging Role Of Online
Communication Between
Patients And Their Provider
Steven Katz M.D. M.P.H.
Associate Professor
Departments of Medicine and
Health Management and Policy
University of Michigan
Agenda





Motivation
Current online landscape
Challenges
Early Experiences
Prognosis
Motivation

Patients
 Frustrated
with between-visit access
 Are increasingly connected online

Providers
 Are
frustrated with between-visit
communication
 Current modes are burdensome, fragmented
and inefficient
 There is enormous mismatch between
communication mode and tasks
Why web is right



It is asynchronous
It has enormous reach
It is robust
exchange and store information
 provide services
 connect people



Communication can be tracked, managed,
documented, and evaluated
It is secure
Great Expectations
The Internet will have a profound effect on the
practice and business of medicine. Physicians,
eager to provide high-quality care and forced by
competition to offer online services, will introduce
e-mail and patient-friendly Web sites to improve
administrative services and manage common
medical conditions. Patients will identify more
health information online and will take more
responsibility for their care. The doctor/patient
relationship will be altered...
Jerome Kassirer. Health Affairs 2000
Trends in internet use1
Type of use
2000 2002
E-mail/IM
55
62
Browsing
55
54
News
38
37
Information
36
33
Shopping
34
32
Any
66
71
1. UCLA internet report 2003 http://ccp.ucla.edu/pages/InternetStudy.asp
UCLA Center for Communication Policy, 2003
Digital Divide
Source: Pew Internet and American Life Surveys
Message Volume*
University of Michigan Primary Care 2002
Time
period
Physicians (N=120)
Email
Phone
1
12
76
2
14
80
3
13
81
4
13
82
5
14
71
* weekly patient messages per 100 scheduled visits
Challenges

Patients



Providers




Lack experience
Digital divide
Workload
Uncertain value of online communication
Little consensus about communication management
Organization



Business model/ROI
Building and integrating online communication tools
No road map
Dr. Katz:
I am a patient of yours through Yellow Care Network. Generally, I
am seen by Dr. Rufus T. Firefly but I have not been able to contact
him nor have I been able to get an appointment to see any doctor
in the Internal Medicine clinic. When I called I was simply told
there were no available appointment times. I am currently
experiencing intense pain when I urinate as a result of a bladder
infection and would very much like to get a antibiotic to start
treating this. The symptoms are constant urge to urinate and
painful urination followed by blood in my urine at the end of the
urination. Can you please facilitate an appointment to see a doctor
in your staff or prescribe an antibiotic. I am not taking any other
medicines at this time.
various news:
1) referral to Diabetes Clinic DOES NOT SHOW UP on their records yet (as
of Friday 01/09)... was seeing Dr. Sugar
2) Am re-enrolled in Stop Smoking Program (she'll use your old referral)
but WILL NEED anti-depressant script soon
3) scripts for imdur (120mg & 30mg) WORKED at pharmacy...
4) referral to Eye Clinic OK... appointment set
5) referral to Cardiology Clinic OK... Dr. Heart said "...see you in a
year..." and "...are 95th percentile of her patients (for exercise
level, walking 3-5 miles /day)". Walked 11 miles last Monday=01/12
6) next apptmt with you(??) 04/02
Thank You
Components of a patient portal



Service-related features
 Medication renewals, scheduling, forms,
registration/billing
A clinical communication tool
 Secure messaging
A patient health record
 Populated from provider and patient data sources
 Medical record
 Patient: current meds, immunizations, health
status information (e.g. blood sugar or blood
pressure log)
Yellow brick road
Develop business model
 Build or buy communication tools
 Develop roll-out strategy

 Map
relationships and workflow
 Develop rules of engagement and exchange
 Develop education and promotion strategy
 Allocate provider effort during rollout
 Evaluate processes and outcomes
Emerald Cities
Start-up Experiences





Patient uptake is slow
Patient online gap
Resource offsets are uncertain
Clinician and staff acceptance is high
“Cultural Divide” between patients
and their clinicians
Patient1 and physician attitudes towards role of
clinic staff in e-communication
Patients: “ OK for clinic staff to handle my [e-mail/Web] messages
for my physician”
Physicians: “OK for the clinic staff to handle patient [e-mail/Web]
messages for me”
Disagree (%)
Email
Web
Patients
47
33
Physicians
14
12
1. Patients who reported regular use of e-mail
90
80
70
60
50
40
Patients
% Preferring Mode
30
20
10
0
90
80
70
Visits
Phone
Online
60
50
40
30
20
10
0
Physicians
Prognosis: Good

Patient facility and access is growing

increase in broadband access
 Better
online communication tools
 Better clinical data systems
 Beginning of the “J curve”
 Uncertain business model