Virtual Patient Encounters

www.ehrpc.com[email protected]

One of the greatest proposed advantages of electronic health record systems is enhanced physician-patient interaction. Most of the recommended EHR products available today include a Web-based portal that facilitates communication, allowing for the sharing of lab results, medication refill requests, and follow-up after an in-office consultation. Many questions arise, though, when implementing these services, and these issues should be considered before making the leap into electronic visits.

Are e-visits secure?

Many physicians and patients are reluctant to embrace health-related electronic communication because they question its security. Given the ever-looming shadow of HIPAA and frequent reports of personal data being stolen by hackers, this is a reasonable concern. In fact, according to SecureWorks, an Atlanta-based managed security firm, electronic attacks on health care organizations doubled in the fourth quarter of 2009. This underscores the importance of ensuring that the communication medium is designed to protect sensitive data.

Most EHR products that include an interactive portal require that both the physician and the patient log in to the same encrypted Web site to ensure that the data stay on a single server and are not mailed through cyberspace, where they can be intercepted and stolen. Such portals also allow communication to be limited to referral requests or lab result notices, which helps prevent unwanted or inappropriate messages from flooding a physician's in-box. Personal e-mail accounts should never be used by physicians or patients to communicate sensitive information. Not only do such accounts lack security, but they provide the possibility for patients to take inappropriate advantage of the professional relationship.

What are the legal aspects of e-visits?

Unfortunately, every advance in health care provides a new opportunity for litigation. With electronic medical communications, several significant legal pitfalls can arise. E-mails that are typed quickly and casually can be easily misconstrued, and once written, such electronic exchanges provide indelible documentation of every interaction. It is therefore very important to be careful when communicating health-related information electronically.

It's a good idea to set guidelines that limit what and how information is to be communicated. In 2002, the American Medical Association produced well-designed guidelines that cover not only the technical aspects of electronic communications, but also include a code of ethics that should be followed when using e-mail. For example, the AMA encourages that e-mail be supplemental to office visits and only be used after a clear discussion with the patient about privacy issues.

More recently, several AMA publications have addressed social networking media, such as Facebook and MySpace. Although these sites can present a great opportunity for marketing and sharing general practice information, they may jeopardize the physician-patient relationship by blurring the line between personal and professional communication.

How do e-visits affect the bottom line?

With an increase in virtual availability to patients, it becomes very easy to foresee a future of electronic visits eliminating the need for certain in-office consultations. Depending on an individual physician's payer mix, this can have a dramatic impact on income. It might benefit those with a high percentage of Medicaid or capitated patients, but it could be greatly detrimental to a practice with a larger share of fee-for-service patients, as it's not clear if and when insurers will begin reimbursement for electronic visits.

Currently, the Centers for Medicare and Medicaid Services limits reimbursement for electronic patient encounters only to regions where there is limited access to health care. In light of the Health Information Technology for Economic and Clinical Health (HITECH) Act, several proposals are being considered that would expand payment opportunities to all areas of the country.

A few private insurers have begun compensating physicians for e-visits. BlueCross BlueShield of North Carolina recently started to offer reimbursement under specific CPT codes. So far, the insurer reports that only 31% of participating providers are using electronic patient communications, while 74% of members desire to interact with their physicians in this way.

As more practices adopt EHR systems and insurers expand reimbursement, the true mark of success will be better health care outcomes and improved satisfaction for both physicians and patients.

www.ehrpc.com[email protected]

One of the greatest proposed advantages of electronic health record systems is enhanced physician-patient interaction. Most of the recommended EHR products available today include a Web-based portal that facilitates communication, allowing for the sharing of lab results, medication refill requests, and follow-up after an in-office consultation. Many questions arise, though, when implementing these services, and these issues should be considered before making the leap into electronic visits.

Are e-visits secure?

Many physicians and patients are reluctant to embrace health-related electronic communication because they question its security. Given the ever-looming shadow of HIPAA and frequent reports of personal data being stolen by hackers, this is a reasonable concern. In fact, according to SecureWorks, an Atlanta-based managed security firm, electronic attacks on health care organizations doubled in the fourth quarter of 2009. This underscores the importance of ensuring that the communication medium is designed to protect sensitive data.

Most EHR products that include an interactive portal require that both the physician and the patient log in to the same encrypted Web site to ensure that the data stay on a single server and are not mailed through cyberspace, where they can be intercepted and stolen. Such portals also allow communication to be limited to referral requests or lab result notices, which helps prevent unwanted or inappropriate messages from flooding a physician's in-box. Personal e-mail accounts should never be used by physicians or patients to communicate sensitive information. Not only do such accounts lack security, but they provide the possibility for patients to take inappropriate advantage of the professional relationship.

What are the legal aspects of e-visits?

Unfortunately, every advance in health care provides a new opportunity for litigation. With electronic medical communications, several significant legal pitfalls can arise. E-mails that are typed quickly and casually can be easily misconstrued, and once written, such electronic exchanges provide indelible documentation of every interaction. It is therefore very important to be careful when communicating health-related information electronically.

It's a good idea to set guidelines that limit what and how information is to be communicated. In 2002, the American Medical Association produced well-designed guidelines that cover not only the technical aspects of electronic communications, but also include a code of ethics that should be followed when using e-mail. For example, the AMA encourages that e-mail be supplemental to office visits and only be used after a clear discussion with the patient about privacy issues.

More recently, several AMA publications have addressed social networking media, such as Facebook and MySpace. Although these sites can present a great opportunity for marketing and sharing general practice information, they may jeopardize the physician-patient relationship by blurring the line between personal and professional communication.

How do e-visits affect the bottom line?

With an increase in virtual availability to patients, it becomes very easy to foresee a future of electronic visits eliminating the need for certain in-office consultations. Depending on an individual physician's payer mix, this can have a dramatic impact on income. It might benefit those with a high percentage of Medicaid or capitated patients, but it could be greatly detrimental to a practice with a larger share of fee-for-service patients, as it's not clear if and when insurers will begin reimbursement for electronic visits.

Currently, the Centers for Medicare and Medicaid Services limits reimbursement for electronic patient encounters only to regions where there is limited access to health care. In light of the Health Information Technology for Economic and Clinical Health (HITECH) Act, several proposals are being considered that would expand payment opportunities to all areas of the country.

A few private insurers have begun compensating physicians for e-visits. BlueCross BlueShield of North Carolina recently started to offer reimbursement under specific CPT codes. So far, the insurer reports that only 31% of participating providers are using electronic patient communications, while 74% of members desire to interact with their physicians in this way.

As more practices adopt EHR systems and insurers expand reimbursement, the true mark of success will be better health care outcomes and improved satisfaction for both physicians and patients.

www.ehrpc.com[email protected]

One of the greatest proposed advantages of electronic health record systems is enhanced physician-patient interaction. Most of the recommended EHR products available today include a Web-based portal that facilitates communication, allowing for the sharing of lab results, medication refill requests, and follow-up after an in-office consultation. Many questions arise, though, when implementing these services, and these issues should be considered before making the leap into electronic visits.

Are e-visits secure?

Many physicians and patients are reluctant to embrace health-related electronic communication because they question its security. Given the ever-looming shadow of HIPAA and frequent reports of personal data being stolen by hackers, this is a reasonable concern. In fact, according to SecureWorks, an Atlanta-based managed security firm, electronic attacks on health care organizations doubled in the fourth quarter of 2009. This underscores the importance of ensuring that the communication medium is designed to protect sensitive data.

Most EHR products that include an interactive portal require that both the physician and the patient log in to the same encrypted Web site to ensure that the data stay on a single server and are not mailed through cyberspace, where they can be intercepted and stolen. Such portals also allow communication to be limited to referral requests or lab result notices, which helps prevent unwanted or inappropriate messages from flooding a physician's in-box. Personal e-mail accounts should never be used by physicians or patients to communicate sensitive information. Not only do such accounts lack security, but they provide the possibility for patients to take inappropriate advantage of the professional relationship.

What are the legal aspects of e-visits?

Unfortunately, every advance in health care provides a new opportunity for litigation. With electronic medical communications, several significant legal pitfalls can arise. E-mails that are typed quickly and casually can be easily misconstrued, and once written, such electronic exchanges provide indelible documentation of every interaction. It is therefore very important to be careful when communicating health-related information electronically.

It's a good idea to set guidelines that limit what and how information is to be communicated. In 2002, the American Medical Association produced well-designed guidelines that cover not only the technical aspects of electronic communications, but also include a code of ethics that should be followed when using e-mail. For example, the AMA encourages that e-mail be supplemental to office visits and only be used after a clear discussion with the patient about privacy issues.

More recently, several AMA publications have addressed social networking media, such as Facebook and MySpace. Although these sites can present a great opportunity for marketing and sharing general practice information, they may jeopardize the physician-patient relationship by blurring the line between personal and professional communication.

How do e-visits affect the bottom line?

With an increase in virtual availability to patients, it becomes very easy to foresee a future of electronic visits eliminating the need for certain in-office consultations. Depending on an individual physician's payer mix, this can have a dramatic impact on income. It might benefit those with a high percentage of Medicaid or capitated patients, but it could be greatly detrimental to a practice with a larger share of fee-for-service patients, as it's not clear if and when insurers will begin reimbursement for electronic visits.

Currently, the Centers for Medicare and Medicaid Services limits reimbursement for electronic patient encounters only to regions where there is limited access to health care. In light of the Health Information Technology for Economic and Clinical Health (HITECH) Act, several proposals are being considered that would expand payment opportunities to all areas of the country.

A few private insurers have begun compensating physicians for e-visits. BlueCross BlueShield of North Carolina recently started to offer reimbursement under specific CPT codes. So far, the insurer reports that only 31% of participating providers are using electronic patient communications, while 74% of members desire to interact with their physicians in this way.

As more practices adopt EHR systems and insurers expand reimbursement, the true mark of success will be better health care outcomes and improved satisfaction for both physicians and patients.