Electronic communications in clinical care will likely not be widely adopted by primary care physicians unless patient workloads are reduced or the doctors are paid for the time they spend using them, according to research from Weill Cornell Medical College, Cornell University's medical school based in New York.

The push for electronic communications has been widely endorsed as a means to improve quality of care by, for example, e-mailing test results to patients, or managing clinical conditions without requiring a time-consuming and costly office visit. And the study found that there is improved patient satisfaction through electronic communication with doctors.

Still, few physicians use it. By 2008, the latest year for which figures are available, less than 7 percent of physicians regularly communicated with their patients electronically, according to Weill Cornell investigators. 

The researchers interviewed leaders of 21 medical groups, and also interviewed the healthcare staff, including physicians, in six groups that use electronic communications extensively, but varied in their approach. The detailed report appeared in the August issue of Health Affairs.

“The lack of compensation is one issue, and another is that unless the practice takes steps to reduce a physician's daily workload of patients, communicating with patients is extra work that makes some doctors feel that their day can never end,” Tara Bishop, M.D., the study’s lead author and an assistant professor in the Department of Public Health and Medicine at Weill Cornell, said in a statement."

Still, pressure from patients and from practice management may ultimately force physicians to communicate with their patients via electronic health records (EHRs) or secure e-mail, Bishop adds. "I think there are ways to make a transition to electronic communications in healthcare work. Our study offers some good examples, but I still think we have a long way to go before physicians routinely e-mail their patients."

The leaders said they started electronic communication programs to improve access to care and communication with their patients. All six practices used the program to communicate test results, to allow patients to request medication refills, appointments, and to ask questions of their doctors. The volume of e-mails that reached physicians in the six programs varied from five to 50 daily.

However, the researchers found the primary disadvantage to using electronic communication is that it creates more work for providers. "One leader said that the work never ends. It takes a psychological toll on some people -- the feeling of never being done," Bishop said. "Another said that in one day, he sometimes sees 10 patients face-to-face but communicates with another 50, commenting that he works all the time."

"Despite the fact that we found experiences with electronic communications were, on the whole, very positive in the groups we studied that have embraced this technology, we believe the big stumbling block to its widespread use around the country will be compensation," said Bishop. "Until different payment models emerge, electronic communication is unlikely to be widely adopted by physician practices."