Doctors at Group Health Cooperative, a not-for-profit integrated healthcare system based in Seattle, are ahead of the curve when it comes to interacting with patients online.
Although nationally only 8% of physicians communicate with patients using e-mail, almost all of our physicians and physician assistants can interact with patients, securely and privately, over the Internet using our own Web portal, MyGroupHealth, at ghc.org. They exchange secure e-mail and share information via a patient-accessible online medical record that includes test results, visit summaries, immunizations and allergy information.
More than 67,000 of our adult patients, or one in four who receive care in our medical centers, have signed up for these services. That's one of the largest installations of its kind in the world.
The key lesson we have learned since we started this work four years ago is that it is not enough to purchase and install technology. Physicians need to lead the work to integrate online access into their relationships with patients in order to reap the differentiation and efficiency advantages of these services.
Managing physician change
To differentiate ourselves in the community based on these services, all physicians must participate -- there is no "opt out." Given physician concerns about the impact of online services on the efficiency and quality of care, we make physician leadership visible to enhance physician confidence in their own success. We also bring patient experiences into the conversation, including patient testimonials and satisfaction scores that highlight patient success using online connections.
The adoption of e-health services within the medical group has been successful because of the alignment of these services with our mission to provide patient-centered care. In our group of 819 medical staff, there are approximately 2.2 full-time-equivalent physicians devoted to physician support in the use of online services and the electronic medical record in general.
The physician leadership also examines time and effort spent on messaging and incorporates this into our variable compensation model so that this effort is counted as "real" work.
Although many national surveys report patient interest in communicating with physicians online, the physician's recommendation is the most powerful force in creating the online connection. While vigorous advertising has helped raise awareness, a personal invitation from a patient's doctor is the most successful strategy for increasing patient adoption of online services.
Surveys of our patient population showed that 74% of patients would willingly go to the Group Health Web site if asked to by their doctor. To lower the hurdles to a doctor providing the personal recommendation, we have equipped our physicians with a templated invitation within the electronic medical record that they can provide to patients when they leave the office.
The patient-physician online interaction is dynamic, and our technology tools need to adapt accordingly. For patients, the desire is for a reasonable response time (within one business day) when they request medical advice online. We have increased our compliance to this standard from approximately 70% to greater than 96% through the use of integrated software and reporting systems that help care teams stay on track.
Patients also expect to know about all test results, whether or not they are in the reference range. We have modified our software to make the release of abnormal results over the Web much easier for physicians by reducing the number of mouse clicks required.
For more and more physicians, the question of whether to interact online with patients is not an "if," but a "when." We believe physician practices can be successful if they work to build adoption among physicians and patients in tandem.
Matthew Handley, M.D., is medical director of health informatics, and Ted Eytan, M.D., is associate medical director of health informatics at Group Health Cooperative, Seattle.