Q. I'm the CEO of a three-hospital group in the Midwest. I attended one of your recent workshops and was struck by your suggestions about the benefits of communicating with our patients by e-mail. If we wanted to do so, what are some of the first steps we might take? And how do I go about convincing our physicians that exchanging e-mail with patients is a good thing?

A. I'd suggest an approach something like the following:
1. You might begin by collecting data on your patients' current use of online communications. Add a space for an e-mail address to the forms or software you use to record patients' address, phone number etc. Have staffers ask each patient if they have an e-mail address. If so, record it. If not, enter "none." Ask patients without e-mail addresses to let you know if they get one.



2. Patients with an e-mail address should be asked the following questions:
   
   • How many hours per week do you spend doing e-mail?
   • How many hours per week do you spend on all online activities?
   • What are the most important things you do on the Net?
   • What health or medical topics have you researched online?
   • Were you satisfied with what you found?
   • Have you communicated with online patients or self-help groups about your concerns?
   • Have you communicated with online health professionals about your concerns?
   • What online health resources and tips would you recommend to other patients?
   • Would you like to communicate with by e-mail?
   • What services could we provide online that would be most useful to you?



3. Report survey findings to your staff and discuss their implications. Encourage physicians and other staffers to ask about patients' online health experiences, to discuss these experiences with the patient, and to note them in the patient's medical record.



4. Look at the sites your patients recommend.



5. Using these sites as a starting place, prepare a list of recommended sites for patients with specific concerns. Ask your smartest and best-informed patients with these conditions to help. Make these resources available on your hospital Web site and as printed patient handouts.



6. Encourage interested staffers to try exchanging e-mail with a few patients. Ask both clinicians and patients to comment on their experiences. Once patients and staffers are satisfied, invite more patients to correspond with their doctors or clinics via e-mail. A good source of guidelines for exchanging e-mail with patients is Danny Sands at Harvard's Center for Clinical Computing: clinquery.bidmc.harvard.edu/People/Daniel/ePCC.htm



7. Once most staff members are comfortable exchanging e-mail with patients, invite all patients to communicate with the appropriate clinic or doctor via e-mail. Add the appropriate e-mail addresses to business cards and stationary. Look for additional ways of integrating e-mail into your practice, e.g. patients with special needs, reminders, patient satisfaction surveys. Use e-mail in combination with your institution's Web site to offer appointment scheduling, prescription refills, individual home pages for physicians, and other online patient services.

If 10 to 25 percent or more of your patients are active users of online services, you should begin studying how your institution can best develop online services. If the figure is 25 to 50 percent or more, developing online services should be a top priority.

To encourage physicians, offer small grants for creative pilot projects using provider-patient e-mail. Add desktop medicine to the job description of appropriate staffers and look for these skills in your new hires. Acknowledge the docs on your staff who are most enthusiastic about online patient services with awards and bonuses and put them in charge of your provider-patient e-mail program and your other online patient services. Be sure that your docs understand that developing such services may be a key to your institution's future: Providers without such links may lose their Net-savvy patients to online competitors.

Published in The Ferguson Report, Number 5, July 1999

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