Why Doctor's Don't Use Electronic Communication

Benjamin Brewer, MD over at the Wall Street Journal gives his take:

When it comes to e-visits my patients don't seem to want another password to remember. And they really don't want to pay the $30 I charge for an online consultation and that their insurance doesn't usually cover.

Maybe patients don't use our email system because we provide good access by phone and in the office.

In retrospect, I should have surveyed my patients before I spent money on a secure email platform and state-of-the-art software for electronic consults. I guess I was a little too far ahead of the curve.

In some parts of the country doctors are using e-visits and electronic communication to good effect. Some are even getting paid for it. We aren't. Our local insurers, Medicare and Medicaid haven't embraced the idea.

Right now it costs my practice $1,800 a year to maintain our cool Web site. The company that provides it wants a $6 transaction fee for each e-visit, and 50 cents for every appointment and prescription refill I process with their software. We haven't come anywhere near covering our costs.

I checked with another popular company and they wanted a $3.50 cut from each visit. Giving 14% or more of e-visit fees to a transaction processor still seems too much.

The cost is too high for small practices for this to really catch on. The right combination of ease of use, price, security and connectivity to physicians' electronic records systems hasn't been found yet.

For the small, independent practice, Dr. Brewer articulates the barriers to entry for many doctors. Larger health systems, like ours, have heavily-integrated secure communication systems that can transmit test results and facilitate communication without the need for "transaction fees." Until such systems become available (and affordable) to rural docs like Dr. Brewer, widespread adoption of electronic medical record systems will be limited.

-Wes