Ready for online appointment scheduling and "Web visits"?

The era of e-medicine may be inevitable, but vigilance can help physicians ensure that it "improves the ways in which we deliver, receive, and pay for health care," wrote John Stone, MD, MPH, in the New England Journal of Medicine (6/14/2007). Stone, a rheumatologist, chronicles his clinic's use of a secure Internet link allowing physicians and staff to communicate with patients.

The clinic adopted an e-medicine model, which included online appointment scheduling, electronic prescription refills, general messaging capabilities (to answer simple patient questions, such as "Should I have a chest x-ray before my next visit?"), and visits" (or structured consultations for nonurgent chief complaints). Although the patients had already started using e-mail to contact the clinic, administrators warned against using standard e-mail to reply. Why? Responses from the clinic were not secure outside of its firewall, a risk that could violate the Health Insurance Portability and Accountability Act.

Stone cites several advantages to e-medicine: Early studies have shown that it improves productivity, reduces the number of office visits, and saves money. In addition, e-medicine could improve transitions of care by providing a means for various providers to communicate easily with one another.

"If physicians are compensated fairly for the expertise, thought, and time required to respond to Web messages in a professional manner, they will build time into their schedules for this task," wrote Stone. Maybe then, he believes, more third-party payers will provide adequate reimbursement for e-medicine in their contracts.