What about eVisits? (Online Medical Evaluations)

For us at Sparks & Favor, the last few years have been amazing! In 2008 we began our transition to electronic medical records. It took quite a while to scan tens of thousands of your charts into our EMR system. That job was just finished this year, so now even our first patients from 1991 have a complete electronic medical record.

In 2012 we overhauled our website and added a social media presence in order to expand or ability to provide up-to-date health information and educational materials.

During the same period, we gained the ability to communicate remotely with Brookwood’s medical records system for our patients. Now if you are admitted to the hospital, we can electronically access your vital signs, lab results, and other information.

And last year we added our Patient Portal. If you have registered to use the portal, you can request appointments, view a summary of your office visit, receive lab results, request prescription refills, and manage your billing account electronically. This has been quite a change!

You may have noticed, however, that we do not yet communicate with you via email (and wondered why). Obviously, technology provides a new forum for patients and healthcare providers to communicate directly about a medical problem without either doctor or patient being physically present in the office. Marketing for online medical evaluations (sometimes called eVisits or known by other terms) can be found in the media and even on billboards around Birmingham.  We’d like to tell you about some considerations that have gone into our decision at Sparks & Favor to approach this cautiously.

In short, regardless of how or where we care for you, we need to accurately identify your problem and respond with the appropriate treatment. More than that, we need to continue to offer the doctor -patient relationship you have come to expect.  As with any new healthcare trend, our physicians evaluate whether the change is better for our patients or just a passing fad. We want our care decisions to be evidence-based—that is, supported by solid research rather than opinion.

At this time, we don’t have sufficient evidence that online medical care improves efficiency, patient health, or patient satisfaction. The few studies that have examined the eVisits raise questions about whether they actually reduce the need for a subsequent office visit to resolve the patient’s problem. One study reports that via eVisits physicians are more likely to prescribe antibiotics–taking a “conservative” approach because they cannot examine the patient. We are very sensitive to serious risks that overuse of antibiotics presents.

What about convenience? After all, the lead message on our homepage says “Allow us to make your pursuit of a healthy life a little easier.” For the moment, we are not confident that diagnosis and treatment of a problem via email will actually resolve your problem more efficiently, even for simple problems like vaginal or urinary tract infections. Email is just not a conversation. When you call our nurse (or the call physician after hours), we have a give-and-take exchange of information. We can ask you more about your symptoms, your history, or other factors that you may not have even thought related to your problem.  True, we could do this over the course of several emails in a thread, but that would definitely not resolve your problem quickly.

We understand your frustration when you have a simple question, and cannot reach your physician’s nurse with one phone call. You leave a voicemail, and then wait for a return call. But when you receive the return call, in one conversation we offer a recommendation for your problem.

We will continue to consider the question of online medical care and review the medical literature for objective evidence of its value. In the future, we may very well add the email feature to our portal. But for now, we are cautious. Our healthcare system is changing rapidly. To accommodate these changes, policymakers look for ways to reduce cost and increase efficiency, and this may lead to care that is more and more impersonal. Future evidence may prove that eVisits provide high levels of patient satisfaction via good health outcomes and convenience. Until then, we will continue to want to have a conversation with you. This is not an area where Sparks & Favor wants to be “cutting-edge.”