Patient Email Satisfaction Starts with Managed Expectations


As more patient-physician communication moves to web-based messaging systems, patients have the ability to contact their doctors at any time, day or night. So now physicians face the question of whether they need to assign call duty to the practice's electronic mail system.

Surveys have found that a large majority of patients are interested in online communication with their physicians; but other studies have found that patient satisfaction rates could decrease significantly if the messages aren't responded to in an appropriate period of time.

Researchers at the Mayo Clinic found that although family physicians generally respond to messages during the week in a timely fashion, the weekends are a different matter; nearly all messages sent Monday through Friday were opened within 12 hours, but on the weekend 87.1% of messages weren't opened in at least 36 hours.

There is no direct evidence that negative consequences or outcomes are associated with longer delays, but researchers want to study further whether there should be a standard for how responses should be sent and how delays in response times affect patient satisfaction and health care decision-making.

Other surveys have found a correlation between patient satisfaction and message response times. A 2003 survey of patients using an online messaging service at the University of California, Davis, Medical Centers' primary care network found that all patients who received a response right away were "very satisfied." The rate of those who were "very satisfied" dropped to 73.8% when a response didn't come until the next day. The more the response time increased, the more satisfaction decreased.

Some experts say managing patient satisfaction goes hand in hand with managing their expectations. Others say how quickly a physician responds may be determined by the design of the messaging system they are using or the way the practice handles messages.

Let patients know when you will respond

Physicians can take specific actions to help set patient expectations regarding physician response time; it is possible to have a high rate of patient satisfaction even if messages are not answered immediately.

For example, when patients sign up for a secure messaging service they may need to agree to terms of use that include an expectation that messages could take up to two business days to be answered.

Physicians can also help set expectations by reminding patients as they go through the process of sending a message that the service is not intended for urgent questions and that a response will take a specified amount of time such as one or two business days. In this case the patient would be taken through a series of screens to determine whether their matter should be handled by email or whether they need to see or speak to someone more quickly.

Transfer email to an answering service

Telephone calls made to a physician practice after business hours are generally handled by an answering service. In a similar way, a possible solution is to re-route electronic messages to a call center.

This solution would require the person answering the message to have access to important information about the patient so that the message can be passed to the right person. Feedback would be required so that the primary care physician will know how the situation was handled.

Another option would be to give patients a choice. They could send the message to an on-call person or a primary care physician with an understanding that there will be a delay in response.

In some practices, when physicians are off duty or on vacation, their colleagues can check messages for them. This is especially true when the messaging system is integrated with the electronic health record system and shows when new messages have arrived. Colleagues have the option of replying themselves or telling the patient that the physician is not available.