Why I love using email with the parents of my pediatric patients
By Mark Groshek MD Kaiser Perma | Popularity: 13%My name is Mark Groshek. I am a pediatrician with Kaiser Permanente in Colorado, and I am the lead physician in our organization for eHealth. Like all the Kaiser Permanente regions, KP Colorado uses an electronic health record from Epic Systems. In May of 2006, we launched on-line access for our adult members to much of their charts, including Email My Doctor, My Test Results, My Allergies, My Immunizations, and My Ongoing Health Conditions. I even sent the first email as a patient to find out when my next checkup was due!
As a pediatrician, it was painful for me that we didn’t have the functionality to be able to let parents use these features for their kids when we launched. So June 26 of 2007 was a banner day for us–we launched these features for parents of kids, and for parents of teens. And we launched direct access for teenagers.
One of the best things about my job is that I split my time between my pediatric practice and eHealth. That means that I get to use the tools I help launch to care for my own patients. I have a baby girl in my practice who had already been hospitalized twice with respiratory problems and an oxygen requirement by the time she was 2 years old. Her mother was not able to care for her, so her grandmother, who is single, was the primary caretaker for her and her older brother, and holding down a full time job as well. She had a lot of trouble getting her referral appointments scheduled at our local Children’s Hospital. So this little girl’s grandmother emailed me the first day. It was so much easier for her to use email to work through the problems with the referrals, and questions about how to adjust her oxygen, and still keep the rest of her life together. I am happy to say things are much better for this little girl a few months and several consultants later. Better yet, we were able to take care of a lot of issues without making her sit on the phone, or have to take time to come to the clinic. She has told me many times (in email!) how helpful this has been to her.
In medical care today, much of the care our patients need is asynchronous–they need information or advice, but it doesn’t have to happen on the spot. Telephone systems are not always very efficient, and can require people to stay on hold. Office visits are terribly time inefficient for our patients–a 10-20 minute doctor visit often involves half a day for our patients. When we need to communicate, but we don’t need to be face to face, email is tremendously helpful. I haven’t really used email with people I don’t know yet, and I think it is likely to be far more helpful when patients and their doctors already have a relationship. But I know from my experience how much it helps my patients, and I love it!
In future posts I will be sharing what we are learning from giving direct access to our teen agers, as well as to their parents.
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November 15th, 2007 at 11:33 am
Mark,
What a powerful example of how valuable these tools can be for empowering consumers and enriching the clinician-patient relationship if used thoughtfully!
As a parent of three young children, I am envious of the access the parents of your patients have to you.
Thanks for sharing.
–Josh
November 15th, 2007 at 3:36 pm
[…] I even sent the first email as a patient to find out when my next checkup was due!” Article Mark Groshek, PCHIT, 15 November […]
November 15th, 2007 at 4:58 pm
Josh,
Thanks! Since I have 2 job roles, I am not in my clinical office every day. Having email also helps me be available to my patients even when I am not there, which is another thing I like about this.
When we first started doing email, many providers were worried that they would be overwhelmed by emails, and that they would include a lot of spam. It turns out, of course, that our patients value having this kind of access, just as you would. Most of the emails we get are very concise, and our patients are very respectful of the physician’s time. I suppose having this kind of access really is extraordinary in some ways. To me, it feels like the most natural thing in the world.
Mark
November 16th, 2007 at 6:45 am
Mark -
I think this is a progressive approach and good to see Kaiser enabling this. Much like clinics, I think that e-visits and e-mail have a place in today’s society. It would probably be possible to do video consults on some issues also to minimize disruption for small issues.
I know whenever I need to reach our pediatrician that it might take her 4-5 calls to get back in contact with me due to my schedule.
Most physicians seem very worried about e-mail both from another task to take on, not getting reimbursed, and lack of information leading to a mistake. I have to believe there is a way to change this.
George
P.S., Trying to think about patients from a health company perspective is what my blog (Patient Centric Healthcare) is about at http://www.patientadvocate.wordpress.com.
November 19th, 2007 at 11:17 pm
Dear George,
You bring up an important point I did not mean to skip over–Kaiser Permanente is an HMO at its core. This means I am not reimbursed for each thing I do, but rather on the basis of taking care of my patients. So it is somewhat easier for us to provide email access than it might be for a pediatrician in private practice who is reimbursed differently.
On the other hand, the market place is changing rapidly, and more and more of KP’s business will be based in self-funded insurance in the future. So we will need to demonstrate the value of providing email access, if we want to be reimbursed in the future.
There is no doubt in my mind that we provide great value to our patients and to their employers with this service. We are working to be able to demontrate that value to the employers as well!
As far as the issue of incomplete information goes, I think it is mostly a matter of learning how to use the medium. At one point, all medical care was based on the face to face transaction. When telephones became available, we learned to use them. I think email is the same. We need to develop a level of comfort. This is easier with people you know. Sometimes we can’t get the picture we need to have to make a good decision on line. There is no reason we can’t switch to the phone at that point. But I think many people have the idea that when we introduce a new technology, it supersedes the old one. That is absolutely not the way we should use email–email should augment the older technologies, but we should never stop using our good judgment, either as patients or as providers.
Mark