• 02 JAN 13
    • 4
    Patient-physician messaging: good for business and bad for healthcare?

    Patient-physician messaging: good for business and bad for healthcare?

    In the Western healthcare system where doctors and healthcare organizations are compensated for maintaining unwell people – it makes perverse sense to keep people sick and churn as many billable office visits as possible.

    Is the current trend of patient portals and online access to EHR (whether the EHR is good or bad, seems to be an irrelevant question) a way of reducing visits (keeping people healthy) or increasing visits (increasing revenue and keeping sick people sick)?

    The tacit assumption today is that online services are a way to wring more efficiency out of the healthcare system; taking care of patients with less office hours.

    We’ll soon see that online healthcare services are good for business and customer retention but do not necessarily improve the clinical quality of care nor patient satisfaction.

    In the late 90s, I managed a regional Microsoft distributor business; we did about $20M/year of business with a channel of over 100 resellers. At the annual distributor meeting in Bellevue WA, I remember Orlando Ayala – a corporate VP at Microsoft telling a group of over 1000 distributors gathered from all over the world, that the 2 keys to success in distributing Microsoft products were a) strong financial backing and b) outstanding information systems for logistics.

    This made a big impression on me at the time; since I realized that Orlando was correct; technological prowess and software know-how was not relevant to running a profitable software distribution business.

    What was key was being able to sustain competitive low margins (“ strong financial backing”) and remain profitable with low margins and high volume (“outstanding information systems for logistics”).

    When I moved on to my next business – people asked me what was it like running a Microsot distribution company; my answer was then and still is: I learned a lot about 2 tier distribution and I could just as easily distribute any commodity; whether it is shoes, cheese or sewing machine spart parts.

    Many people in the hospital, HMO and health insurance management business take a similar view to healthcare managent – healthcare is a commodity where the operation needs to be optimized, proft increased and costs decreased by widespread using of IT.

    This is true for any business and healthcare is no exception.

    A late 2012 article published in JAMA: “Association of Online Patient Access to Clinicians

    and Medical Records With Use of Clinical Services ”, Palen, Ross, Powers, XU examined whether patient portals and provision of online access to EHR could help wring efficiency out of the systeml; reduce costs and increase patient satisfaction.

    Using health information technology to foster efficient health care delivery is an important component of health care reform… patients desire online access to their medical records and e-mail communication with their clinicians.


    The Institute of Medicine report “Crossing the Quality Chasm: A New Health System for the 21st Century” posited electronic patient-physician messaging as a promising technology to improve the quality and efficiency of health care…some reports estimate that 25% to 70% of all visits to physicians do not require face-to-face appointments.


    The study shows that having online access to medical records and clinicians was associated with increased use of clinical services compared with group members who did not have online access.


    This is a very compelling argument for a healthcare provider to implement patient-physician messaging as a promising technology to increase the number of billable visits without necessarily improving the quality and efficiency of health care.


    The study concludes with the thought that “that the relationship between online access and

    utilization is more complex than the simple substitution of online for inperson care…


    In a way it’s good that patient-physician messaging increases the number of visits.


    It’s good for business. Not necessarily for your health.



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