Docs, it's time to embrace online chat and texting with patients

Neil - Are you out of your mind? Although this technology is very attractive - and I am a device geek - as a physician, I have a concern about secure and private communication - just like e-mail - that is not adequately addressed. Until a secure connection can be established, prying and unauthorized eyes might see some communications thereby jeopardizing patient privacy. Also, attorneys will want copies of ALL communication between the doc and patient. Where are copies of every communication stored for future retrieval and is that site secure? Lastly, many patients will want to do an office visit via this device and often do not understand the merits of physically being present in front of a doc to improve the ability to understand an issue that arises. Is our time as physicians so worthless that we continue to devote our time and energy without being compensated in a fair manner? Could this method of communication be billable?

HIPPA concerns, legal nightmares ahead, and the real issue is billable hours. Unlike lawyers, accountants and other professionals, docs are primarily compensated via insurance. The big insurers are not stepping up to say they will in any way support chat, video conference or even secured email consults.

My company provides web sites and IT solutions for medical providers (can I plug docwebtrc.com??) - and it kills me that there is no good way to leverage the available technology to improve care, streamline procedures and most importantly cut costs.

I mean, it is criminal that the Federal Gov't has to bribe the majority of docs to even go on EMR. If any of those idiots in Washington were serious about healthcare reform; then mobile solutions and leveraging smart phone technology in a way that fairly compensates docs would be at the top of their wish list.

Cigna and Aetna have been reimbursing for online consults since January 2008.

Actually, as the physician mentioned in Neil's comments, the comments made above are the same concerns any responsible clinician would and should have about communication methods that are leveraging commonly available technologies and tools. However, if responsible and accountable clinicians take the time to self educate or share best practices on these issues, one realizes that HOW we leverage these tools is key. The issues of knowing what is private, secure, what level of information one shares, whether you store/copy/paste elements of communications is just as important as it relates to faxing and phone calls as it is for chat/im/video, etc. Anyone who experiences this type of workflow and looked at the nature of advanced communication tools can see the following.. One has NOT actually put names or very sensitive info linked to names in messages. Things like GTalk and other IM tools automatically creates a copy of the entire transaction in your inbox for later copy/paste/storage anywhere you think is important. If you have a brief video interaction with a family of a patient you are asked to help make a decision about you feel MORE secure and MORE private because you can see/interact and sense far better who you are communicating with, read subtle expressions of comprehension of risk discussions, etc. And in fact, if one focuses FIRST on clinician efficiency, something often lost in the EMR and other worlds of healthcare IT...then when more ubiquitous reimbursement models to evolve for all modes of communication...those modes will be far more adopted because they actually enhance efficiency and security, not diminish them. Of course, using any tools/methods of communicating, collaborating, documenting without knowing the limitations as well as potential of such tools is a risk for anyone. That also applies to all sorts of modes of communicating, from "in person, to phone, mail, progress notes, IM, video, email, etc"

I do believe clinicians will feel far more empowered if they can recognize the enabling aspects of these types of tools, all of which are becoming cheaper, easier, more reliable and, yes, more associated with various customized methods for privacy/publicity balance. The healthcare IT industry is notorious for making all of us docs feel we can NOT do these types of things for some reasons of compliance, etc but the IT industry is rarely as accountable as we are at the point of care for making good decisions and ensuring that people are kept safe and have reasonable clinical outcomes. I have found even in my role as a hospital based stroke neurologist, that leveraging communication tools patients/families/nurses/other doctors are all familiar with in their daily home lives makes it easier to collaborate and get everyone on the same page. And if you cover a busy ER and have accountability for alot of decisions made with amazingly little information, having a gateway back and forth that is both open AND "private peer to peer" when needed, but that also eliminates the inefficiency of phone calls/phone tag, etc....achieving this type of workflow is so transformative.

On a final note, I do believe that the real point of the comments from Neil was the principles and concepts around leveraging new methods that are well supported by the telecommunications industry to help us become more self-empowered. Whether it is this tool/that tool, this secure message system, or that document sharing process is less important than the principles one adopts in this regard. But I do agree with the comments and issues, take those very seriously in how I talk with other clinicians about how they address their own workflow needs...and believe that one of the most important things nowadays is that we educate ourselves about all aspects of communications and share our stories,,,both good and bad.

Thanks