I'm blogging about physician communications, more specifically physician online communications using Internet technology. I am not a physician; my work responsibilities are highly interdependent and support the work flow and relationships of primary care and specialty care physicians. I have been working in the field of Internet technology and health care for the past 10 years and have been in health care for 25+ years. I'm employed in a large integrated health care delivery system in the Midwest, Community Health Network, Indianapolis IN. We don't have all the answers. We strive to be one of the leading systems in the U.S. in the arena of inpatient and ambulatory care, electronic medical record utilization.

My intent is to share thoughts and ideas about our experiences related to physician communications using technology such as intranets, extranets, blogs, corporate and personal email, IM, texting, and new media techniques with streaming audio and video. From my preliminary investigations, I have found limited research on the web or blogosphere specific to this important topic. So my agenda is to put some content in play and begin to contribute to that void for any interested individuals or groups to benefit from benefit from. Please comment honestly, directly and respectfully.

In the context of this post email means: email between physicians, physician office to physician office email and organization email  to physician email.
There is a wide spectrum of technology adoption (AKA browser, keyboard and email comfort level) by physicians affiliated with our organization.  There are those who do not use email and have no desire to use ever it (this is a minority) In contrast there are physicians that use email every day, even throughout the day via notebook pcs and  hand held devices such as the Treo, Blackberry or iPhone.

The physicians’ comfort level and skill with the keyboard, mouse and Internet browser is significantly inter related to their perception of web application and intranet usability. Further, this mouse and browser comfort level is influential to the physician adoption of email into their respective daily work flow.

In our organization all physicians either have a corporate email address or are entitled to have one upon request. Corporate email addresses are more frequently used by physicians who have dual administrative  and clinical roles or frequent business communication within the organization. It would be a generalization, but relatively safe to state that the largest volume of physicians using corporate email to communicate are the financially integrated physicians. While general medical staff and specialty physicians tend to use personal email addresses to communicate with one another about non clinical topics.

To assure the protection of personal health information (PHI) our organization utilizes a secure email gateway. This provides a solution for a physician with a corporate email account to send confidential, private communications and information that may due to its referral or collaborative purpose, contain personal health information securely to another physician. The physician receiving the secure email can be using a personal email account to receive the prompt that they need to securely access the gateway to read the content within the message. For example, a physician can send a secure email by simply prefacing his / her email’s subject line with the text “secure:”. An example subject line might read, “secure: Patient j jones blood work results”.

Most physicians affiliated with our network have personal email accounts such as Yahoo, MSN, AOL. These email accounts may be specific to the physician or be a family email account that is shared. As well these personal email accounts change, new ones are added.

This train of thought leads to the discussion of; what data / information should be communicated via email and what data/information should be communicate via the intranet or a portal? Further, what criteria should be used to discern this question and whom can or should make this final determination?

 

We identify the categories of physician work processes that can be facilitated by intranet/portal as:   Communication, news (customized to the physician), relationship management information, business operations (meeting minutes, forms) and quick access to Clinical systems.

Our physician's regularly remind us that in their view a physician portal has to be: simple, easy to get to, clean, few clicks, and everything is right on the home page. Of course this seems logical to them, its not always realistic, when it comes to managing intranet real estate. Our physicians also, rightfully so want single sign  for all systems and applications. Physicians, practice managers and office staff have various system access or short cuts on their respective personal computers (PCs) to specific clinical systems and business systems to get their work done. We are currently striving to create a “most convenient” manner to access that is specific to role and a single sign on solution, but there are many security operations management tasks to address. In the end, it becomes a question how secure is secure enough balance with a favorable physician experience that will stimulate greater online engagement.

There is a spectrum of physician readiness regarding Internet technology acceptance. Some influencing factors include; physician's work and home access, perceived quality of usability, the amount of the individual physician's browser and email experience. Physician engagement in the use of technology has been a very staged and gradual process. It has taken some 8+ years (in our organization) to accomplish the current primary care adoption rate of the EMR (> 70% of total), portal and email usage (don't have definitive measures on these yet). We see ourselves as progressive, but relatively early in our physician e-culture journey. Within this spectrum there are physicians of all ages who embrace technology and are willing to expend the energy to learn "how to" get stuff done. Others, do not have the tolerance, or are at a point in their professional working lives that they do not desire to expend such time on transitioning their respective work flow and clinical practice. That is by the way a key phrase to focus upon "work flow!"

Key learnings regarding physician web based technology engagement:

• Influential peers make a difference
• Measurable, improved clinical outcomes speak volumes
• Financial incentives can play a part
• Reproducible time effectiveness drives change
• Motivated, enthusiastic office staff essential
• Temporary, focused, additional support resources a must
• Effective governance structure must be in place to achieve large numbers

Physicians highly value physician to physician, face to face communication time. As is the case with the rest of the 21st century world there is gradual decrease in real time, much less face to face communication. Physicians don't come to the hospital for professional social networking the way they used to. They still want and need data and information. They have more mechanisms to access it within an increasingly compressed time cycle to manage it.  The question at hand is "what is going to drive physicians to physician specific, secure portal/intranet or a corporate email account?" A text book answer might read like "more convenient connectivity to each other to clinical systems, more efficient workflow, CME, rapid access to reference material & to pose clinical questions / care plans / protocols / evidence based data."

The content / data we all desire to share can be broadly categorized into the categories of communication/news, relationships/political, business operations and clinical operations. These diverse categories make physician intranet / portal and email adoption challenging but, it also (we believe) holds the secret to success.  Our experience to date regarding the adoption of electronic medical record (EMR) or corporate email would indicate that a one solution approach will not be quickly accepted by the majority. There is no magic solution that will remedy all physician e-culture challenges. Progress will be achieved through an evolution of education, experience and acceptance.  Ong and Polkowski et.al. 2001 writes that "It is possible to create and diffuse an Intranet in a multi-hospital system in a cost-effective manner. However, the key challenges were selling the potential of this new technology to opinion leaders and other stakeholders...."

This is an admittedly incomplete list of topic related articles, and I will promise to continue to add to this list as we may find relevant.

Online Physician Communications Related References

Medical intranet success factors
Healthcare Financial Management,  July, 1998 by Edward Fotsch
Obtained from the World Wide Web June 9, 2007
http://findarticles.com/p/articles/mi_m3257/is_n7_v52/ai_21045765

Medical intranets: new technologies expose old problems
Healthcare Financial Management,  March, 1998 by Edward Fotsch
Obtained from the World Wide Web June 9, 2007
http://findarticles.com/p/articles/mi_m3257/is_n3_v52/ai_20633688
 
Intranet Dashboard a Lifesaver for Sentara Physicians, March 16, 2007
Obtained from the World Wide Web June 9, 2007
http://www.intranetjournal.com/articles/200703/ij_03_16_07a.html
 
Building and Growing a Hospital Intranet: A Case Study
Kenneth R Ong, 1 Michelle Polkowski, Geoff McLemore, Mark Greaker, and Malcolm Murray, Kenneth R Ong
Obtained from the World Wide Web June 9, 2007 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1761884
 
The portal advantage. Hospitals lure docs with easy access to medical records
Greene J., Hospitals & Health Networks / AHA [Hosp Health Netw] 2001 Oct; Vol. 75 (10) pp. 56-8