Throughout healthcare, there has been a recent push for electronic communications to be used more frequently as a means to improve quality of care. Examples include emailing test results to patients or managing conditions without requiring time-consuming and costly office visits. “Despite the push, few physicians use electronic communications,” says Tara F. Bishop, MD. A 2008 study showed that less than 7% of physicians regularly communicated with their patients electronically.

In Health Affairs, Dr. Bishop and colleagues had a study published to investigate how different practices used electronic communication and the associated benefits and barriers. They interviewed leaders of medical groups that used electronic communications extensively but varied in their approach. Five of the six groups were large; four had more than 500 physicians, and another had 115 doctors. Participants used electronic communication programs to communicate test results, allow patients to request medication refills and appointments, and ask questions of their doctors.



Perceptions & Hurdles

According to the results, electronic communication was widely perceived to be a safe, effective, and efficient means of communication. Leaders of medical groups reported that it improved patient satisfaction and saved time for patients. “The advantages were obvious and sometimes outweighed the disadvantages,” says Dr. Bishop. “We were told that patients favored this model. Leaders and frontline providers said the system helped them provide high-quality care.”

“Unless the practice takes steps to reduce a physician’s daily workload, communicating with patients is extra work that makes some feel that their day is never ending.”

Despite its advantages, electronic communication also increased the volume of physician work. “Many physicians said that while electronic communication may help patients, it’s a challenge for them,” adds Dr. Bishop. “Unless the practice takes steps to reduce a physician’s daily workload, communicating with patients is extra work that makes some feel that their day is never ending. This can take a significant psychological toll on physicians.”

Another significant issue to overcome is the lack of compensation, says Dr. Bishop. “Physicians felt that they should be paid for the time they spend phoning and emailing patients, both during and after office hours. Although electronic communications were well embraced, the big stumbling block to widespread adoption will probably be compensation.”

Potential Solutions

Practice redesign and new payment methods are likely needed for electronic communication to be more widely used in patient care. “Using team-based care for managing electronic communications and workload and compensating physicians for their work in ways other than traditional fee-for-service are potential options,” says Dr. Bishop. “Pressure from patients and practice management may ultimately force physicians to communicate with patients via electronic health records or secure email. There are ways to make a transition to electronic communications in healthcare work smoothly, but we still have a long way to go before this becomes routine.”


Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff. 2013;32:1361-1367. Available at:

Dwamena F, Holmes-Rovner M, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2012;12:CD003267.

Hassol A, Walker JM, Kidder D, et al. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Inform Assoc. 2004;11:505-513.

Tufano JT, Ralston JD, Martin DP. Providers’ experience with an organizational redesign initiative to promote patient-centered access: a qualitative study. J Gen Intern Med. 2008;23:1778-1783.

Leekha S, Thomas KG, Chaudhry R, Thomas MR. Patient preferences for and satisfaction with methods of communicating test results in a primary care practice. Jt Comm J Qual Patient Saf. 2009;35:497-501.

Teutsch C. Patient-doctor communication. Med Clin North Am. 2003;87:1115-1145.