Security would remain a problem. How secure is “secure” email? I can’t know as that is not my profession. I do know that security professionals declare things secure only to see them hacked later–happens all the time. So where it is really a concern, there must be continued unease about outsourcing the trust to third parties not directly under my doctors control.

One problem with the privacy issue, is that people will often not really care at one moment “I don’t care if I am leaving a hackable paper trail–it is just my blood pressure” and care a great deal at another when a different set of circumstances arise that they had not imagined might occur making the matter more salient.

To address Dr. Parker’s question. Yes, I believe the security question has been solved. However, not for everyone. Essentially you need to either be within a health care system that provides for something termed “secure mail”, which essentially provides you and your patient with a way of exchanging email securely, or you need to pay for a third party to provide such a service.

Finally, I personally allow many of my patients email access to me. However, people reading this should be aware that a physicians burden of time is multiplied across hundreds to thousands of patients. For those in primary care (family practice and such) this burden could become overwhelming quickly. For myself (an acute care surgeon and surgical intensivist), the burden is manageable but it still costly to my time. Also, recognize that all patients are not the same. I gave one patient access to me who underwent a minor procedure without any complications. That patient emailed me 5 times before surgery and 8 times after. I can’t imagine how many times I would have exchanged email had the surgery been complex or had any postoperative complications.

Finally, its well known that society allows lawyers to bill for every minute that they pick up a phone (no matter if they are talking directly to you or if they are simply talking to someone about you), but we have clearly decided that doctors cannot engage in the same practice of billing. That’s OK. But we need to be frank. We can’t ask our doctors to work any harder and continue to reimburse them less. So therefore there needs to be a better plan than simply asking your doctors to start responding to email all day and not pay them for it. New systems of health care need to be designed, but the mess that we are in now is so complex its almost impossible to figure out how we are going to clean it up.

JFS

In other words, security and privacy were problems.

Has that problem been solved? To me, that’s the first hurdle. Payment is second.

Even the governor of Alaska in 2008 had here email account hacked!

-Steve

I'm aware that docs don't get paid for email so if they give me their address, I use it sparingly and am very brief and to the point. In 4.5 years I've emailed my oncologist twice and my geneticist once, each time with brief questions that couldn't wait until my next visit but weren't urgent enough for a phone call.

Since I already receive this service from my health plan I can’t say how much I would pay for it broken out. I suspect that it’s added at least $60 to our yearly premium, and frankly I don’t really want to know for certain!

I’ve emailed my doctor twice in the past two years. That would make each communication “cost” $60 under this plan.

I would probably prefer to purchase emails like a book of stamps. Maybe 10 emails at a time. so I’d pay $60 and get 6. If I was in the middle of some involved treatment or had a problem that involved a lot of test results that would be worth it I could re-up, if I continued on at my current rate I’d be set for six years.