"The work never ends."
The advantages of electronic communication in these groups were obvious and they outweighed the disadvantages, says Dr. Bishop. "We were told that patients love this model. Leaders and frontline providers also said the system was efficient, safe, and helped them provide high-quality care. Physicians also said it was an efficient form of communication for them."
The researchers found the primary disadvantage to using electronic communication is that it creates more work for providers. "One leader said that the work never ends. It takes a psychological toll on some people -- the feeling of never being done," Dr. Bishop says. "Another said that in one day, he sometimes sees 10 patients face-to-face but communicates with another 50, commenting that he works all the time."
The researchers found that physician resistance to change and lack of payment are barriers to use of electronic communications. "One leader told us that insurance companies said that if physicians are doing it for free, why should we pay for it?" Dr. Bishops says.
While electronic communications does seem to reduce office visits for individual patients, many physicians do not have a decreased overall workload -- their clinics send them additional patients to see, she adds.
She says these issues can be addressed by team-based care that manages electronic communications and workload, or by compensating physicians for electronic communication in ways other than traditional fee-for-service, which does not yet include payment for time spent on emails, Dr. Bishops says.
"Despite the fact that we found experiences with electronic communications were, on the whole, very positive in the groups we studied that have embraced this technology, we
|Contact: Sarah Smith|
Weill Cornell Medical College