Practice management experts urge docs to use the Web

Susan R. Miller, RN, suspected that business was being lost during the office's peak calling periods. So she did a study.


PHILADELPHIA—Susan R. Miller, RN, administrator for Family Practice Associates in Lexington, Ky., suspected that business was being lost during the office's peak calling periods. So she did a study of phone procedures and found that, when patients were placed on hold, 65% of them would hang up within two minutes and 90% would hang up after four minutes.

The opening reception of the Medical Group Management Association was held at the National Constitution Center in Philadelphia
The opening reception of the Medical Group Management Association was held at the National Constitution Center in Philadelphia.

“Our concern was that once we lose that call, we've lost that patient,” said Ms. Miller, a speaker at the Medical Group Management's Association's annual meeting here in October.

Her solution was to move Web-savvy callers online. Today, her practice still answers the phones, but staff lowered call volume simply by asking “Do you use e-mail?” Once on the Web site, patients can refill prescriptions (with a drop-down list of pharmacy options so patients choose exactly which Wal-Mart or CVS they want the prescription called into), pre-register for visits (saving time and space in the waiting room) and pay bills online.

Once a practice has a database of patient e-mail addresses, staff can also send reminders for preventive health care, such as flu shots, or alerts on new medication warnings or device recalls, Ms. Miller added.

As people increasingly expect to interact with their doctors via e-mail and the Web, physicians must respond or risk alienating potential patients, said several other speakers at the MGMA meeting. “I have heard a lot of discussion about the threats that are coming from consumer-driven health care, and there's no doubt that there are some, but consumer-directed care is also creating new opportunities for physician practices to benefit by improving patient satisfaction while simultaneously cutting practice operating costs.,” said Donna Kinney, a medical economics specialist with the Texas Medical Association.

Virtual communication

E-mail communication with their physicians is one of health care consumers' primary demands. Several presenters cited a Harris Interactive poll that found that more than 70% of U.S. adults have Internet access and that 80% of them want the option to ask their doctors questions online.

A majority of patients also want to go online to schedule visits, renew prescriptions and get lab results, the poll found. These services are relatively easy for practices to provide and can reap financial benefits in addition to improving patient satisfaction, according to the panelists at an MGMA session on redesigning the patient experience.

Although they require a little more Internet infrastructure, e-visits are another growing trend in medical practice Web sites, noted co-panelist Stephen Malik, who is the CEO of Medfusion, a health technology company. “One of the factors that is also driving the consumer-driven health care model is that there is now a CPT code for online care. As more of these payers are starting to reimburse for that, it creates additional opportunities,” he said.

E-visits can be as simple as a secure, online area in which patients enter a question for a doctor or nurse and then receive an e-mail alert when a response is available. The secure system is preferable to using regular e-mail because it avoids potential HIPAA problems (if the patient e-mails from a work account which an employer monitors, for example) and can be set up to save the interaction to a patient's electronic health record, the experts said.

Storing health records

Edward Fotsch, MD, was involved in the development of the online CPT code, but he believes the next big trend in online medicine will be personal health records. He is CEO of Medem, Inc., a company which provides physician communication and personal health record (PHR) products.

Various insurers have tried to launch personal health record programs and met with little success because patients don't want to reveal information to them. “It's like your car insurance company sending a survey about your driving habits,” said Dr. Fotsch. Patients are more willing to provide the necessary information, such as family histories, eating and exercise habits, to their physicians than to an insurance company, he added. The insurance company can then help keep the data in the patient's record current and also use the PHR network to deliver health reminders to patients.

Personal health record systems, which can include all of the previously mentioned online connections to the practice, enable patients to receive tailored patient education materials specific to their conditions or demographics. Patients can also permit whoever they choose to view their records, so that specialists, emergency physicians or hospitalists could have access to the same information that the patient provided to the primary care physician, Dr. Fotsch said.

He predicted that patients will increasingly look for personal health records and online services more generally when choosing a new physician, at the same time that medical malpractice carriers and payers push medical practices to use Internet resources to boost quality and efficiency. “It's in everyone's best interest,” said Dr. Fotsch.