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Article Title

Categorizing Patient-Provider Secure Email Communications to Measure Substitutionary Effect on In-Person Services

Publication Date

4-30-2015

Keywords

secure email, patient-provider communication

Abstract

Background/Aims: Previous observational studies have reported conflicting results when evaluating patients’ use of secure email and their use of in-person clinical services. Different studies have found that secure email between patients and health care providers may substitute for, increase, or have no impact on the need for in-person clinical services. In this study we used diagnosis codes and order codes associated with emails to categorize the type of email communication. We then evaluated whether particular categories of emails substituted for the need for in-person clinical services.

Methods: We used retrospective data from Kaiser Permanente Colorado members over the age of 18 who were continuously enrolled for at least 30 months in 2010–2013. We identified which emails contained diagnosis code(s) and or order code(s). We categorized emails containing diagnosis code(s) into low acuity conditions based on diagnosis-related group categories. We then determined if the patient had a subsequent in-person appointment.

Results: Health care providers added a diagnosis code to 19% of secure emails, and 85% of these members did not have a follow-up visit or telephone call in the next 30 days. Health care providers placed a coded order within a secure email encounter 21% of the time, and 85% of these members did not have a follow-up visit or telephone call in the next 30 days. Only 8% of secure emails for low acuity conditions resulted in a follow-up visit within the next 30 days. This is comparable to rate of follow-up office visits for low acuity conditions.

Discussion: Secure email communication between patients and health care providers may substitute for the need for in-person clinical services for specific circumstances and conditions.

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