The doctor is in : don't be surprised if the next time you talk to your health care professional it's through a videoconferencing setup, e-mail or a cell-phone text

National Women's Health Report, March, 2009

These days, clinicians are using electronic texts for quick consults, to send reminders to their patients about appointments and to keep a cellular "eye" on hospitalized patients and by receiving text alerts if their condition changes.

Meanwhile, some doctors have turned to video e-mails to deliver more personalized test results or to create educational videos to help information "stick" with patients. (23)

Patients are taking the lead as well. When the on-call neurologist could not figure out what was causing her three-week-old daughter's seizures, Tracey Blackman of Woodbury, CT, used her digital camera to document a seizure, then uploaded it onto an online photo service. She then contacted several experts around the country, sending them the link so they could "see" her daughter in the midst of a seizure.

"The higher level of communication allowed us to make a more educated decision of where to have her transferred (for specialty care)," she said. Once transferred, her daughter was put on monitoring equipment. Even though the baby's doctor was not in the hospital that night, he was able to access the results from home in real time. "By the time he saw us at her bedside the next morning, he already had a preliminary diagnosis," said Ms. Blackman.

There arc potential downsides to electronic medical communication. Elizabeth A. Scars, PhD, a workplace communications expert in Scottsdale, NY, finds the new methods of patient-physician communication "disheartening." She has a good friend who was driving in the car when his doctor called to inform him he had prostate cancer. "Did he remember any of the conversation? In time, I believe the lack of compassion generated by the new methods of communicating with each other will result in a host of other problems."

Even as physicians move into the future with technology, some are opting for new practice models that move them back into the past, when a family doctor had time to really get to know your family. Their solution: Concierge, or "boutique," practices.

Doctors in concierge practices, which tend to exist in metropolitan areas, significantly limit the number of patients they see, and typically charge patients an annual fee, often thousands of dollars, to join their practice. For that money, you get a doctor who is on call to you 24/7 (you probably get his or her cell phone number), intensive annual physicals, same-day appointments and the type of oversight and coordination of specialty care that simply doesn't occur in most traditional practices these days.

Some concierge doctors quit ail insurance plans. But most practice a form of "hybrid" concierge in which they charge a monthly fee of about $100 to $150 but still participate with insurance plans, said Wayne Lipton, managing partner of Concierge Choice Physicians, a company that helps doctors transform their practices. The extra fees go to cover the cost of providing "extras" such as counseling, as well as greater access.

Murray Taylor, MD, a family physician in Rancho Mirage, CA, transformed his practice three years ago. "The ability to spend more meaningful time with my concierge patients has reinvigorated my practice," he says. "It's the way generations of physicians before me have cared for patients. I know my patients, they know me, therefore I can better manage all their health care needs."

RELATED ARTICLE: Electronic Medical Records: The Time Is Now

The $787 billion stimulus package President Obama signed in February included about $20 billion for electronic health records (EHR). While most hospitals have computerized their records, physician offices have been notoriously slow to jump on the EHR bandwagon, despite evidence they can improve efficiency and quality, primarily for primary care professionals. (21)

Yet a national survey of 2,758 physicians conducted in late 2007 and early 2008 found that just 4 percent had an extensive, fully functional system, with just 13 percent having even a basic system. (22)

Those who adopted the technology were mostly positive about it, with 80 percent saying it helped them avert prescribing a drug to which a patient was allergic, and 71 percent saying it alerted them to a potentially dangerous drug interaction.

"I'm a big fan of the e-office," says internist David Hundt, MD. His entire Williamsburg, VA, office is automated. Each exam room has a computer, and all data is entered into it for every visit. Dr. Hundt can type in a prescription and send it securely over the Internet to a local pharmacy; search for medication interactions; and even track phone messages via the computer.

Since one of the major reasons physicians cite for not adopting an EHR is financial, the stimulus money may be just what the doctor ordered.