Medical “e-visits”—electronic communications between patients and physicians, primarily via secure messaging—have been touted as a low-cost method for doctors and patients to stay in touch without the time and expense involved with office visits. But, so far, they seem to be doing more harm than good, according to new research from the Wisconsin School of Business at the University of Wisconsin–Madison.
In reviewing five years of healthcare encounters (e-visits, phone, and in-office) for more than 140,000 patients, the researchers found:
- Providers adopting telehealth or digital doctor visits experienced a 6% increase in regular office visits.
- The additional visits resulted in an added 45 minutes per month of additional time doctors spent on those visits.
- To make up for that additional time spent on office visits, there was a 15% reduction in the number of new patients seen each month by those providers.
- There was no observable improvement in patient health between those utilizing e-visits and those who did not.
The research report says the increased frequency of regular office visits associated with could be a “gateway effect” of giving patients the chance to bypass the usual gatekeepers, such as office staff and nurses. It’s plausible, the report says, that more communication with the physician, by its nature, creates more opportunities for a physician to feel obligated to schedule an office visit.
“In many aspects of our lives, we’re using omnichannel services,” says Hessam Bavafa, Wisconsin School of Business assistant professor of operations and information management and a co-author of the study. In higher education, Bavafa says, that means his students are more likely to send him messages than meet with him during office hours. In retailing, this could mean using the web to buy an item that is later picked up in a store.
“It’s important for health systems to figure this out in order to do it well,” Bavaf says. But healthcare—like ridesharing services and retailing—needs to keep experimenting and sharing ideas that work, he says.
In order to make e-visits workable, Bavaf says, three main major barriers need to be overcome:
- Interactions between doctors and patients are far more complicated than, say, shoppers and retailers. It’s hard to accomplish via e-mail. Patients, for example, might overreact to minor symptoms or not be clear enough in describing their situation—leading doctors to feel obligated to schedule an office visit.
- For patients, adopting e-visits means that it takes less time and energy to reach out to a doctor, which leads them to do it more. The result is that doctors end up spending a lot of time responding to those patients.
- Compensation also is a problem. While doctors know they will get paid for office visits, they usually do not get paid specifically for e-visits, meaning that they do not have an incentive to make them the primary communication channel with patients, Bavaf says.
The findings suggest that e-visits are beneficial for providers that are not at capacity and can easily absorb the increase in office visits. For those that are at or near capacity or struggling with a shortage of physicians, Bavafa suggests they consider more structured e-visits. For example, before sending any message, patients would be prompted to answer more detailed questions that might provide doctors with better information.
“E-visits are just one feature of the online portals being offered by many providers that allow patients to access lab results, medical histories, appointment schedules, and prescriptions,” says Bavafa. “By taking a closer look at how both patients and providers are responding to this new model of service delivery, we can try to make this channel a more effective tool for improving the health care system.”