One Physician's Journey Into e-Success - creation of www.iscoliosis.com Web site - Industry Trend or Event

Health Management Technology, August, 2001 by John T. Smith

Using the Internet and electronic communication has become an essential part of my scoliosis practice. Contrary to the opinion of some physicians, I believe the proper use of technology will bring efficiency gains, not losses, to physicians while it simultaneously strengthens patients' participation in their healthcare self-management.

About five years ago, I observed that many of my patients had searched the Internet for information about scoliosis before they came to see me. Much of the information they brought with them to appointments was either wrong or misleading. As a result, I spent more time correcting bad information than I spent educating patients correctly about their problem and my recommendations for further treatment.

In response, Dr. Sohrab Gollogly and I created www.iscoliosis.com, a website to provide patients with information about scoliosis and its treatment. I asked patients to review this information both before and after their first office visit. After the first visit, I gave my patients my personal e-mail address to use if they had further questions. Over the year, this process has added significant efficiency to my practice that was unrealized before the technology was available.

I began to discuss this process with other doctors and soon saw that my enthusiasm for information technology and Internet access might be the exception rather than the rule. Other doctors found the prospect of creating a website overwhelming, and many feared that providing their e-mail addresses to patients would be dangerous at best, and would further burden their increasingly demanding workload. In contrast, clinical residents I spoke with all seemed to expect to use this technology in their practices, and uniformly embraced the application of information technology. Clearly enough, that tells me that attitudinal change among physicians is imminent.

Heart of the Matter

Faced with the apprehension I saw in my colleagues, I conducted a survey of my patients about their use of the Internet for access to health information and for communication with their doctor. I reviewed 236 completed surveys from patients and their parents during the fall of 2000, specific to our pediatric orthopedic practice that emphasizes the treatment of spinal deformity in children. I think that the responses are typical of today's young parents in seeking healthcare information.

The first thing I learned is that patients (and their parents) are indeed wired. Some 90 percent have access to a computer either at home or work. Eighty-seven percent of the respondents have access to the Internet either at home or work and more than 80 percent use the Internet.

Sixty percent of families surveyed had specifically sought health information over the Internet. The most popular sites were WebMD, Medscape and Dr. Koop. However, many were reluctant to discuss this health information with their physicians, and even today, the reason for this apprehension is unclear. For those who had not used the Internet as a source of health information in the past, 50 percent said they planned to do so in the future. That means patients are wired--and getting more wired.

Physicians and Websites?

Should physicians have their own websites to provide health information to their patients? My survey indicated that 65 percent of my patients felt that doctors should have a website and that they would be more likely to trust healthcare information if it came to them from their own physicians, rather than the generic information they found on the Internet. Trust within the doctor-patient relationship is a very significant issue that often influences the course and success of a patient's healthcare.

E-mail has become an integral part of modern communication. Cyber Dialogue noted that more than 30 million patients want to communicate with their doctor using e-mail and other forms of electronic communication. However, most physicians are reluctant to use e-mail communication with their patients.

Currently, only 10 percent of doctors actively communicate with their patients by e-mail. However, Dr. Edward Fotch has noted that this represents a 200 percent increase over the past year. Concerns regarding ease of patient-physician access, confidentiality, legal responsibility and lack of compensation for the encounter have been publicly cited as the major causes for physicians' resistance.

The American Medical Association has established guidelines for doctor-patient communication via e-mail, and yet many practitioners are afraid that they will be inundated with email. A Dallas physician even stated publicly that giving out his e-mail address would be "the kiss of death," and that his consultative time was the only commodity he had to sell.

Patient Preferences

In my survey, 82 percent of responding families had an active e-mail account and 87 percent said they would like to use e-mail to communicate with their doctors. Is this reasonable?

My experience has been very positive. The never-ending pile of charts on my desk with requests to call patients back and answer questions is getting smaller. I believe that there are several reasons for this that may be unique to our practice.