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Can I Just Email My Doctor?

San Fransisco, 20 Juni 2005, uit USA Today

90% van de volwassen patiŽnten zou graag willen communiceren met hun huisarts via e-mail. Maar helaas reageert maar 20% van de artsen op de gestelde vragen.
Loopt Amerika dan niet voorop? Zijn de problemen die we in Nederland hebben dan dezelfde als in Amerika?
Toch is er wel een verschil. Amerika loopt voorop als het gaat om het wegnemen van drempels voor een volwaardige invoering van e-health. Met name de regelgeving op gebied van security, autorisatie en authenticiteit (ben je degene die je zegt te zijn)
Per april 2003 is elke zorgverlener verplicht om binnen het Elektronisch PatiŽnten Dossier (EPD) gebruik te maken van de HIPAA standaard. (Healthcare Insurance Portability and Accesibility Act).
Doen ze dat niet risceren ze een geldboete tot maximaal $250.000 en gevangenisstraffen tot 10 jaar per geval. (bron: RVZ-02/06, publicatie 2002)
In Amerika lijken ze dus 1 ding in ieder geval te begijpen, als je het niet afdwingt wordt het nooit wat.

Er zijn 2 grote problemen:
-Hoe zorgen we ervoor dat de communicatie veilig is en overeenstemt met de HIPAA regelgeving?
-Hoe zorgen we ervoor dat de diensten vergoed en betaald worden?

Medem, is een netwerk van 90.000 zorgverleners, hun praktijk en hun patiŽnten waarbinnen veilig via e-mail gecommuniceerd kan worden.
Blue Cross/Blue Shield,, waar 1 op de 4 Amerikanen verzekerd is, is een voorloper op gebied van vergoeding en betaling van patiŽnt-docter e-mails. Ze noemen dat "online visits" en betalen $20 voor zo'n visit.

Het volgende artikel werd geschreven door Suzanne Leigh, Medical Reporter in san Fransisco.

Prescription for doctors: E-mail, By Suzanne Leigh

It was my sixth attempt to reach my doctor by phone, with a simple query about a prescription. "The doctor is with a patient right now," intoned the receptionist ó again.
I took a deep breath. "Would it be possible to reach him by e-mail?"
There was a pause. "The doctor doesn't have an e-mail address."
No e-mail address? My doctor practices in the shadow of Silicon Valley.
"He'll try to call between patients," she said.
And so I waited, held hostage by the phone, like most patients who need to make contact with their doctors but don't require a face-to-face consultation.
In a 2002 survey by Harris Interactive, 90% of adults with Internet access indicated they want to communicate with their physicians via e-mail. But a survey last year by Manhattan Research, a marketing information and services firm, found that less than 20% of physicians communicate via e-mail.
The top reason doctors give for withholding their e-mail address is the fear that it will lead to "too much access" and they will be barraged with messages about "trivial matters," according to a Journal of Family Practice article in 2001.
In other words, patients can't be trusted not to abuse our doctors' time. But if doctors finally moved into the high-tech age, they'd soon discover that many of their concerns about e-mail are misplaced.
Last month, the journal Pediatrics confirmed what disgruntled patients have known for a long time: E-mail can save the doctor's time, too. Researchers evaluated e-mails sent between two pediatricians and 54 parents of patients over six weeks. They found that of the 81 e-mails generated by parents, 70 required just one e-mail response. Most focused mostly on medical questions. And far from being deluged, the physicians said they spent an average 30 minutes a day responding to e-mails. Parents, as a result, reported fewer phone calls and appointments.
To David Bates, chief of general internal medicine at Boston's Brigham and Women's Hospital and director of the American Medical Informatics Association, the appeal of e-mail is that, unlike the phone, it doesn't require both parties to be present simultaneously. "We can handle problems quickly, when it is convenient for both of us," he says.
So what's holding doctors back from e-mailing patients? Let's allay a few other concerns about e-mail:

ē Privacy. The American Medical Association has recognized that e-mail is a "viable avenue for patient communication" and has established guidelines doctors should follow, including getting a patient to sign a consent form in advance, and acknowledging certain limitations to e-mail privacy and confidentiality. Nevertheless, to address this privacy concern, Medem, the for-profit communication network the AMA co-founded in San Francisco, has developed a physician-patient e-mail system in which messages are stored in a secure server and accessed via the user's ID and password. RelayHealth of Emeryville, Calif., provides a similar system.
Patients, whose doctors subscribe to this service by paying about $25-$50 per month, can have online visits for non-urgent health concerns and would get responses usually within 24 hours.
ē Liability. The Doctors Company, a malpractice insurance carrier, endorses secure messaging systems, although Medical Director David Troxel says it's "still too early to know if this will reduce the risk of liability." But Greg Hinson, a family physician in Nantucket, Mass., has little doubt that exchanging e-mail with patients cuts the risk of litigation, because it is a key part of "active and open communication." A patient who can reach out to his physician online is less anxious and more likely to have realistic expectations about his treatment, says Hinson, who exchanges up to 20 e-mails daily with patients. As a result, a patient is less likely to sue if there's a poor outcome. At the same time, e-mail enables physician and patient to clarify information that might not have been clear in office visits and "bounce ideas back and forth and help us to avoid medical errors," he says.
ē Reimbursement. Physicians can charge for their time online. Patients can undergo an online consultation for about $25. Using RelayHealth's system, a patient completes an interactive form and the physician responds with a personal message plus optional links to health care information. Medem's system is similar, and in more than 50% of cases, doctors waive the fee, CEO Edward Fotsch says.
Even so, some doctors are wary of using the service when few insurers provide reimbursement. "Patients are used to having care that is meaningful covered by insurers," Bates says. "The message insurers send by not covering online visits is they aren't valuable."
That appears to be gradually changing. Ten health plans and insurers in California, New York, Florida, Massachusetts, Tennessee and Colorado are paying RelayHealth's subscriber doctors for "webVisits," the company says. Empire Blue Cross Blue Shield says it pays doctors $20 for an online visit; patients are responsible for the $5 co-pay.
Coverage seems to make financial sense for insurers. This high-tech approach cut total health care claims by more than $3 per member per month, according to a Stanford University study of patients using the RelayHealth system for online visits from 2000 to 2002.

Developments safeguarding e-mail, reduced liability, and the willingness of some insurers and patients to pay for online visits mean doctors are running out of excuses for not reaching out to their patients on the Internet. With the demands of managed care requiring less face time spent per patient, electronic communications should become an integral part of the doctor-patient partnership.
Physicians do us a disservice when they fail to recognize this.

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