Electronic Communication in Health Care: Benefits and Risks

Introduction

Electronic communication has become one of the most important methods for people to communicate with one another in recent years. Spielberg (1999) noted that patients have sought to utilize electronic communication with their physicians. In the past, he argued, a variety of exchanges were utilized, including in-person visits, telephone, pagers, and voicemail, so it was only natural that communication between patients and those within the medical profession would extend to the realm of electronic health communication. The market has therefore driven health care organizations to explore how they can use email, the Internet, online chat, and SMS messaging to bridge the communication gap with their patients. While the market may demand new methods of communication, there are risks inherent to the medical profession that present significant challenges to facilitating these electronic communication methods.

Key Issues in Electronic Health Communication

One of the most important issues with respect to the health care profession and its clients is the management of electronic health care records. There is a broad industry movement to convert health care records to electronic format. Any record in electronic format can, logically, be delivered to any number of people over the Internet — something that is generally not possible with paper records. Patients increasingly want access to their records, but significant issues arise when electronic health records are transmitted between health care organizations, or even within a single organization.

In general, patients prefer electronic access to their health care records. There is a widely held sense that care is improved when both patients and other health care providers have access to a patient's records, and online communication of these records is the fastest and most efficient means of achieving this. Some studies have shown that patients prefer email and other forms of electronic communication for routine transactions — such as prescription renewals — but prefer in-person communication for more complex or serious matters (Hassol et al., 2004). The implication is that health care organizations should focus their electronic communication primarily on routine transactions, which inherently reduces the security risk, since the most sensitive communications will not take place online.

Since the use of electronic communication mechanisms in health care tends to be patient-driven, it is important to understand how patients want this information used and transmitted. Winkelman, Leonard, and Kossos (2005) note that "patient use of electronic medical records (EMR) holds the potential to improve health outcomes." The authors cite four reasons: the promotion of a sense of illness ownership, patient-driven communication, personalized support, and mutual trust. When patients feel they have some control over the process of managing their illness, they tend to experience better outcomes. For many patients, exerting this control means using the methods of communication with which they are most familiar. Younger patients in particular prefer electronic communication for interacting with their health care organizations.

For health care organizations, electronic communication of medical records creates value in several ways. First, it meets patient needs directly. If patients prefer this form of communication, market forces will, over time, direct more business to organizations that deliver on that preference. Although the first generations truly comfortable with electronic communication have not yet entered their peak health care-consuming years, the industry must begin to adapt now. When these generations become major consumers of health care, they will demonstrate a strong preference for organizations that meet their communication needs. As Winkelman et al. (2005) also note, health outcomes are improved when electronic health care records can be transmitted to other providers, shortening transfer times and enabling multiple providers to have access simultaneously. Superior health outcomes reduce liability for providers, and patients who remain healthier longer continue to consume health care services. There is therefore a compelling case — both in terms of outcomes and the bottom line — for health care organizations to embrace electronic communication of health information.

Patient Benefits and Outcomes

There are, however, real risks associated with transmitting health care records to patients via electronic means. Annas (2003) notes that the passage of the Health Insurance Portability and Accountability Act (HIPAA) represents a significant shift in how the privacy of health care information is managed. HIPAA is subject to ongoing interpretation and adaptation as it is brought into the electronic age. Health care organizations are bound to follow HIPAA's requirements for maintaining the privacy of patient medical records, even when those records are electronic and transmitted via electronic means. Organizations must be alert to file and email encryption practices, as well as website security issues, before implementing any program to increase the use of electronic media for the transmission of health records.

Health care today is already experiencing positive effects from electronic communication between health care organizations and patients. Patients use their health records in a number of ways that are only made possible by electronic dissemination. Cimino, Patel, and Kushniruk (2002) note that some patients access their medical records more than once per day, and that patients almost universally use this access to review their laboratory results. As a result, patients tend to understand their conditions better. This not only improves a patient's attitude toward their treatment but also improves the quality of communication between patient and medical staff. Improved communication is one of the major factors affecting outcomes, so better communication generally leads to better medical results.

Conclusion

The upside, of course, is that with all medical records being electronic, many of the traditional barriers to learning and communication between patients and the medical professionals who serve them will be removed. Medical practitioners will be able to access a patient's medical history immediately. Patients will be empowered not only to engage in more communication with medical staff but also to feel more confident in their own health care decisions. This has the potential to change consumption patterns, which have developed in an environment where patients often know little about even their own medical history. The more patients know, the more likely they are to shop around for medical services. This dynamic is part of the broader vision behind the Affordable Care Act and its health information exchanges. Ultimately, the industry will be affected because organizations will need to become more competitive in order to attract more knowledgeable and more empowered patients. These changes may well begin to materialize within the next five years alongside the other developments outlined above.