March 31, 2009
Would you be willing to pay $60 a year for the privilege of having an online conversation with your doctor?
That's what the Santa Cruz Medical Foundation is about to find out.
You know how it is when you try to reach a doctor. You call the office, wait in line for the receptionist, explain what you want. Then you wait.
Here's how the doctor sees it: An e-mail arrives from the receptionist. The doctor reads the message in between seeing other patients, sends a message to the medical assistant, who calls the patient. It could be 15 minutes or more.
An online system, which made it possible for 120,000 patients at Santa Cruz Medical Foundation to check their medical records online, receive lab results and make an appointment for free, now allows them to e-mail their doctor for a fee of $5 a month.
Patients will have to decide whether they would rather phone for free or pay to use e-mail.
Dr. Michael Conroy, 46, an internal medicine specialist, is among the early adopters of the new system.
On Friday, he responded via e-mail to a patient who had a blood test drawn by another physician, looking for his advice based on the results.
"I got a clear, unfiltered message from the patient and replied immediately," he said. "It saves patients' time so they don't have to wait on the phone."
The new system was championed by Dr. Paul Tang, chief medical officer of the Palo Alto Medical Foundation, parent of the Santa Cruz Medical Foundation. Tang is an advocate of electronic health records and a member of a new organization formed to promote the creation and use of a nationwide health information system.
In the Palo Alto area, which implemented a secure online system several years ago, about 45 percent of patients signed for the free services. About 6 percent use the e-mail message service for which there is a charge.
In Santa Cruz, about 16 percent of patients have taken advantage of the online system since it become available a year ago.
"They are universally ecstatic about the service," said Dr. Larry deGhetaldi, noting the system is secure to comply with privacy regulations and children under 18 are not allowed online access.
The e-mail message service is so new, the number of people using it is negligible, he said.
Not all patients are enthusiastic about paying for the privilege of e-mailing their doctor.
Scotts Valley resident Janet Bostrom, who used to work in hospital administration, sees the online system as a stride forward to schedule appointments and renew prescriptions, but she doesn't think doctors should charge for accepting e-mail from patients.
"That's what the doctor's job is," she said.
She suggested the doctors' group offer a small number of free e-mails per year to patients and ask for feedback.
From Texas to Ohio, Tennessee and New Jersey, doctors have started charging $25 to $30 for an e-visit, where they evaluate a patient who fills out an online form. These so-called "mouse calls" are geared toward dealing with non-urgent but common ailments.
About 36 percent of doctors in the United States communicated with patients online last year, up from 31 percent in 2007, according to a survey by Manhattan Research. Those who don't communicate online are concerned about privacy issues or legal liability -- or they feel they should be paid for the time they spend answering e-mail.
Medicare doesn't allow doctors to bill for e-mail or e-visits, but deGhetaldi is hopeful that policy will change eventually.
Some doctors fear they will be inundated by e-mail, but Conroy said that has not happened in Palo Alto.
"The experience is that e-mails substitute for phone calls," he said. "It's a tremendous savings in time and convenience."
Since the new e-mail system went live in February, he has been getting about one e-mail a day.
"Most patients are quite discriminating," he said.
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