How does one differentiate a legitimate e-mail from spam if one does not recognize the sender? Safe computing requires one not to open unrecognized e-mail to protect from viruses, worms, etc. I may allow patients to e-mail me, but I cannot guarantee I will open the message if I don't recognize the name of the sender.

Why do I get the impression that it comes down to doctors not wanting to be bothered, not wanting to learn new ways of doing things, and not wanting to forego reimbursement?

The main problem with e-mail appears to be the liability issues involved. I had to give a deposition recently in a malpractice case involving one of my partners and the plaintiff lawyer spent conciderable time questioning me trying to find a smoking gun in our e-mail. We use e-mail to correspond with some patients and I was concerned that the patient(plaintiff) might have had a correspondence with my associate that never made it to his medical record, thus implying that we have shoddy medical records or such (no correspondence existed).After this deposition we've shut down our office e-mail account and don't plan on restarting it.I know the trial lawyers will say we over reacted and are being silly, but why should we take the risk at all?

Regarding the 10:07 message : the e-mail should be integrated in the EMR the same day. Wouldn't you have the same problem with a phone message ?

Not having an email interface in the future is going to be like not being reachable by phone or not taking insurance. Sure some of your patients will tolerate and others will go elsewhere. Also, the more alienated you make your patients, the more likely you will be sued.

"I do this sort of automation and process improvement stuff for a living as network/systems administrator. There are entire industries that are required by law to keep not only e-mails this way but phone conversations as well (the securities industry is pretty advanced in this sort of thing).

There is no reason why doctors must have shoddy systems that make it difficult to keep e-mails with patient charts."

Great idea, but there is an enormous gulf between the resources of a company with a well-funded IT department and a large committment to communications software and the kinds of resources typical for a small medical practice. Secure email archiving and filing requires a well-integrated, secure, reliable EMR and practice management system, and well-trained staff to maintain it, all a significant investment for a very small business. Someday, hopefully, reliable systems that aren't highly proprietary (and highly vulnerable to becoming technological dead-ends, as some systems have in the past) will be available at prices a small practice can afford. But that time isn't now.

"Not having an email interface in the future is going to be like not being reachable by phone or not taking insurance. Sure some of your patients will tolerate and others will go elsewhere. Also, the more alienated you make your patients, the more likely you will be sued."

A little dramatic, don't you think? Many practices operate websites and have automated information on hours, services and other practice-related information. Most do not do medical consultation by email. As far as being reachable, phone and fax is still the standard. E-mail is not preferred, except seemingly by the few who haunt online blog sites. Most patients seem to have no interest in e-mailing their doctors. I doubt that will change anytime soon, either.

As far as insurance goes, it is only as good as it pays. If a company has a crummy reimbursement schedule or an abusive claims payment practice, few doctors will want to take it.

Kaiser actively solicits email interaction with their patients. They are begging people to use email.

The nerve of some people. You cancelled my operation and didn't let me know. According to federal regulations, you owe me $400 and a free operation as soon as it can be scheduled.

The nerve of some people. You won't accept my insurance even though I've been coming here every Thursday for two years.

The nerve of some people. You make more than commercial airline pilots and you have the nerve to whine about money constantly.

I'm pretty sure EMRs, email, and e-prescribing are going to be part of healthcare whether you like it or not. You can embrace it and make it work for you or you can bitch and moan and be forced to do it against your will (or retire).

"According to federal regulations, you owe me $400 and a free operation as soon as it can be scheduled."

Where did you get this idea, Elliott? This is bunk, I think you made it up.


"The nerve of some people. You won't accept my insurance even though I've been coming here every Thursday for two years."

Does your insurance actually pay fairly, or is it one of those crappy policies that promises to pay but hardly does? What is your problem Elliott? Can't you find a doctor willing to take your insurance? Every Thursday for two years sounds like everything is OK with you, or have you got some other problem?

"The nerve of some people. You make more than commercial airline pilots and you have the nerve to whine about money constantly."

Sorry, Elliott, no one owes you their work for nothing, no matter what you think they earn. Grow up already. And which airline pilots were you referring to, pilots working for the starting commuters at $18,000 a year or trans-oceanic pilots with extensive experience who work 12 days a month at $200,000+ per year? And what is the merit of your comparison, anyway? Sounds like a combination of sour envy and misinformation on your part.

"I'm pretty sure EMRs, email, and e-prescribing are going to be part of healthcare whether you like it or not. You can embrace it and make it work for you or you can bitch and moan and be forced to do it against your will (or retire)."

Probably someday, once someone wants to pay for it. The problem is the systems are expensive, and haven't really been shown to save money for practices even in the medium term, (records retrieval and strorage savings do not offset acquisition, training and maintenance costs of these systems). And then the email issue gets us back to earlier posters' points: it is more work for no pay, basically a non-starter. When patients back up their demands by something meaningful, like being willing to pay for the extra service they want to consume rather than just pique at not having something for nothing, then you may see the service you want.

"Sounds like a combination of sour envy and misinformation on your part."

Oh the irony.