Question: I have a simple health question that I want to ask my doctor. But his office says I have to book an appointment to see him in person. Why can’t doctors be like everyone else and send emails?
Answer: It’s true that the medical profession can sometimes seem stuck in the past. Just consider the shocking estimate that two-thirds of Canadian physicians still rely on archaic fax machines as a primary means of communicating with other health care providers such as specialists, pharmacists and hospitals.
When it comes to their own patients, many busy doctors are reluctant to start using emails, partly because they’re concerned about finding themselves on call 24/7. Another disincentive is the fact that most provinces and territories don’t pay physicians for doing emails—British Columbia is the notable exception.
Even so, some doctors see advantages in communicating with patients through email.
“It’s easy for patients, and oftentimes it’s also easier for physicians,” says Dr. Sharon Domb, a family physician at Sunnybrook Health Sciences Centre in Toronto.
But, she is quick to add, “doctors have to follow all kinds of regulations and that’s where the whole system becomes troublesome. “
First and foremost, physicians are responsible for safeguarding patient privacy—and emails are vulnerable to hacking or being misdirected.
The Canadian Medical Protective Association, the body that provides physicians with legal support, warns doctors that they need to have a discussion with their patients about the potential risks of privacy breaches. It also advises that patients should sign a consent form, acknowledging the risks, before any emails flow back and forth.
To further complicate matters, many of the provincial and territorial bodies that regulate doctors stipulate that electronic communications need to be documented in patients’ medical records.
“Where possible, it is advisable to copy all email correspondence for the chart, particularly those dealing with matters of significant clinical impact,” says a policy statement of the College of Physicians and Surgeons of Ontario.
Yet Domb points out that it can be time-consuming and cumbersome to attach emails to a patient’s medical record.
All told, much stands in the way of electronic messaging. But a pilot project, underway in Ontario, aims to remove the key barriers.
The pilot is being run by the Ontario Telemedicine Network (OTN), a not-for-profit organization funded by the provincial government.
“We are trying to come up with a strategy that will help doctors do this—and do it in the right way,” says Dr. Ed Brown, OTN’s chief executive officer.
A key component of the pilot is an app that enables patients to send secure text messages to their doctors from smartphones, tablets or computers.
The physicians can then text back answers. “If doctors think a question needs more explanation, they can do an audio call or book time for a video call,” says Brown. The app also makes it possible for doctors to send prescriptions directly to pharmacies and order lab tests for patients.
Doctors are paid $15 by the pilot program for a completed text transaction. If they have to do a video chat, the compensation is equal to an office-visit fee, which can vary depending on the nature of the appointment.
So far, the pilot has recruited 275 physicians who, in turn, have enrolled 29,000 of their willing patients.
Brown said the messaging system is not meant for urgent matters or medical emergencies. “I think people recognize pretty clearly that it’s not for complicated things. But used appropriately, it is a fabulous tool.”
Of course, important details still need to be worked out before the pilot goes mainstream. The texting system must be integrated into physicians’ electronic medical records, and that’s challenging because doctors are using different systems. What’s more, a flat fee may not be the best way to compensate all doctors. (Some physicians are essentially paid a salary based on the size of their practice and the demographics of their patients.)
Brown notes that groups of Canadian physicians have recently established online services (such as www.getmaple.ca ) which provide medical assistance, and some patients are apparently willing to pay for the convenience.
But Brown would prefer to see patients connect with their own family doctors, because that’s the best way to ensure consistent medical care.
“Virtual technology is going to have a big impact on the future of medicine. And right now, we’re in a race to empower primary care providers so that they can make electronic messaging a part of their normal practice,” he says.
“We hope the pilot will help us work through some of the issues holding it back.”
Dr. Nihal El Khouly, a family physician in Bolton, Ont., has volunteered to be part of the project. “We need to be innovative and this is one way we can give better access,” she says.
She notes that many of her younger patients want to be able to communicate with her electronically. Meeting those needs, however, can potentially add to a physician’s workload.
So, she says, it’s important to manage patients’ expectations and make sure they are aware that it may take a while for her to respond.
El Khouly usually reviews her messages once a day to see if a patient has a request needing relatively prompt attention. She deals with most of the questions in an hour that she sets aside once or twice a week.
“The patients love it,” she says. For some, it means they don’t have to book time off work or arrange for daycare because an office visit has been avoided.
Aside from benefiting patients, the messaging system can help doctors do their jobs.
El Khouly says she recently had to contact a patient after obtaining the results of a medical test. “I had to see him urgently. So I requested a visit with him (through the app) and he responded immediately.”
It also enables physicians to use their limited time more efficiently. “By dealing with the minor concerns online I am freeing time in my office for complex patients,” explains El Khouly.
Sunnybrook’s Patient Navigation Advisor provides advice and answers questions from patients and their families. This article was originally published on Sunnybrook’s Your Health Matters, and it is reprinted on Healthy Debate with permission. Follow Paul on Twitter @epaultaylor.
If you have a question about your doctor, hospital or how to navigate the health care system, email AskPaul@Sunnybrook.ca
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FORCE DOCTORS TO USE EMAIL :: PATIENTS HAVE NO FAX
Inbox
John Gilbert
Sep 16, 2021, 7:00 PM (21 hours ago)
to dgrinspun, Jesse, me
Hi Doris,
I’m an 85 year old fellow progressive, very deaf. Please feel free to give me any tips on forcing doctors to communicate by email. I’ve been in a war with doctors and hospitals trying to get them to communicate by email only. Please bookmark my email message and tell your membership to send it far and wide. (I have included no blind carbon copies.) I sent a copy to Jesse Schulman who was handler for my wife Margo Luhtanen a week ago:
Here is the reason I wrote to you – a link you can read in one minute:
https://www.doctorsofbc.ca/policy-statements/health-information-technology/email-communication-patients
in solidarity,
John Stanley Gilbert Read in a 2 seconds glance —> John Stanley Gilbert’s Facebook
411 Duplex Avenue, Toronto
Email: godhas4legs@gmail.com
~~
Why not start a Whistleblower’s contest: Every month the donor will pay $10.000.00 (BKG would probably fund for it for 2 years – $24,1000.00 )
please add this message to the link to the website of our database of bad doctors: bad because they refuse to allow the hearing impaired to communicate by email.
I can understand a physician not wanting to use email for medical consultation except in emergency (such as the current pandemic). But the techno-resistance goes much deeper. I have to spend ages on the phone to make an appointment, when a “booking page” on a doctor’s website, or an email to his or her assistant/receptionist would be far more efficient. To prep me for a recent surgery, the surgeon’s office snail-mailed me atrociously photocopied instructions, with illegibly scrawled schedule info. An email or URL would be far more useful. At every new appointment I spent 10-15 minutes filling up medical history info on clipboarded forms. That data is then laboriously retyped or entered by another staff member. I could be entering the info directly, online, and save myself time, aggravation, and risk from shared clipboards etc.
I am in the healthcare industry in both an IT and privacy role. Any attempt to institute procedures and policies that improve security, privacy, and facilitate better electronic communications in line with global standards is met not just with disinterest but with hostility and outright rejection. Shocking to me both personally and professionally. Physicians are dictate to the rest of the community, and hold us hostage due to the nature of their specialized knowledge.
I like the notion of email to my Dr , keeping in mind personal security.
Sometimes a simple email can deal with a matter without waiting in an office.
Yes, Doctors should be paid for it , in an equitable manner.
The onus should be on the tech giants to make email much more hack resistant.
This article is so timely and should be available for discussion with the public. We have a solution for Telus called Health Myself which is secure email messaging and online booking connected to our EMR. It is a fabulous service but I am not remunerated to doing this care nor does the MOHLTC have any code that I can shadow bill to show how I reduce the in office burden, (creating convenient care so desired by the public), and that I am providing care within my capitated FHO agreement. Currently the MOHLTC feels I am paid for doing reduced care when in fact this care is over and above all office face to face to encounters.
I am surprised that an OTN solution is developed that is not connected easily to an EMR and I apologize if it is and I am simply ignorant.
I agree that virtual solutions are key for things such as follow up questions, simple investigation results, rashes and questions such as “do I need an office visit for…..”. Many administrative concerns are easily answered through Health myself as well.
But to suggest that the implementation of this saves staffing or reduces my work load is not true. Could it …..maybe but changing patient behaviour rather than simply allowing additional access for issues that patients would not normally ask me has occurred. There are days I feel like “google”.
Thanks for opening the conversation in this forum. It has made the rounds on Twitter too.
I have bee fortunate to have had my last two Family doctors in the last decade plus accept and respond to email. it has proven efficient and served us both well
Lots of misconceptions about privacy issues: he CMA and others do nothing to help … they fan the flames.
Lots of patients have email accounts and they trade personal details about their lives everyday with businesses, family and friend … whether it’s financial, employment, family, relationship details etc.
Physicians simply need consent and to explain the risks to patients if patients want these kinds of communications over an unsecured email system … just like they do with everything else in their lives. End of story.
The REAL ISSUE is that physicians don’t want to communicate by email because there’s not a specific fee code for them to get paid for sending an email, but there is a fee code for having a patient in their office, even though many physicians, especially primary care physicians in Ontario, get paid on a capitation model where it doesn’t matter HOW the physician communicates with a patient.
Follow the money – physician opposition to email is just about money, greed.
(There are physicians who do not fall into this trap. My FHO family doctor is quite prepared to communicate by email or text about simple matters and I’ve signed a consent for that purpose. It means I don’t have to show up in his office and he can dispense with a simple inquiry quickly at his convenience. I also saw a specialist at a hospital recently who was also prepared to answer quick follow-up questions about post-operative care by email. Those physicians put patients first!!).
I think this phrase “”It also enables physicians to use their limited time more efficiently. “By dealing with the minor concerns online I am freeing time in my office for complex patients,” explains El Khouly.””
captures a big flaw in the current system of how doctors are financially compensated in our national healthcare system.
It would save precious taxpayer funded medical dollars – if cases / patients were cared for/ treated in a way that provided an adequate standard of care (which needs to be defined) in the most effective and efficient means possible. This means the removal of any incentives in conflict with that.
How can we get on to this pilot program?
When both patients and health care professionals have full access to the complete EHR, why not just have eg. a physician put a note of communication to the patient (and vice versa) directly on the EHR ? Then some signal can be sent to the intended recipient advising them to check the specific EHR for a message. That way it remains private and is fully documented. The timeline for responding and the financial implications can be dealt with separately. Adding more portals or more apps just gets us away from simplicity.
How does the OTN system get the info into the patient’s health record? It’s great to be innovative, but as we see so often we have siloe’d systems for this type of thing. Some hospitals’ electronic health records systems include a patient portal that enables patient-provider communication that is automatically tied to the patient record. Some doctors will phone patients back to answer simple questions. But I confess I have also faxed my dr more than once in the past…
dear sir,
the article on e-mail is far off base. if you think faxes or e-mails are more secure than e-mail, you are not living in modern times. Doctors and hospitals are the only ones in our society that still use fax machines that i know of. Young people in fact, with few exceptions, do not own one. My grandchildren do not even know what they are!
If doctors don’t want to do e-mail, they should get other jobs.
The protected monopoly of the Canadian medical system means that such flat earth thinking still survives.
HAA
“The protected monopoly of the Canadian medical system means that such flat earth thinking still survives.”
Sums this up.
Canadian studying medicine in Australia. Not only can you email your doctors here, you can also call and (sometimes) speak to them directly. No middle man needed to ‘protect’ the physician, or whatever. Doctors are not gods. They are not celebrities. They are in fact, public servants. Nobody has died from this (that I am aware of). Imagine that kind of efficiency.
Yup and how much does an MD in Australia make? (avg in AUS is 101k, avg in CAN is 225k) Over in Europe, docs make a decent wage slightly better than average but same as other professionals like engineers or teachers. You dont see this issue of a specialist making 500k and thinking they are god. Here how can you possibly even ask your ortho to spend 5 extra precious seconds checking emails from patients…they need that time to talk more people into hip replacements (before even offering other suggestions like physical rehab and weight loss) so they can fund their million dollar mortgages and yachts in Oakville. Until you find a billing code for email consults dont expect docs in Canada to go above and beyond, majority are purely money driven and the fee for service billing code model is the reason for enormous health care costs and a focus on quick band aid solutions rather than finding root causes of health issues.