Jodiey Bondurant, a PhD student at the University of Colorado Anschutz College of Nursing, is the co-author of a research paper called “Securing Health Conversations: Crafting the Right Business Model for Patient e-Messaging.” In this recently published research, Bondurant and Professor Mustafa Ozkaynak, PhD, MS, discuss the impacts of electronic health messaging systems (EHMs) on clinicians and patients and how to find the best business models to benefit communities.
What are electronic health messaging systems (EHMs)?
Electronic health messages are similar to texting. These chat systems are often used by patients to ask their clinician a question without meeting in person or via telehealth. This can be a quick way for patients to communicate with their healthcare team.
PhD student Jodiey Bondurant. |
“Anytime someone interacts with a health record, they have the opportunity to send a message directly to a provider or clinician,” Bondurant says. “They can send various types of messages, like a non-urgent medical question, a prescription question, or just anything else.”
Bondurant worked as a nurse practitioner in a rural hospital outside of St. Louis, where she gained first-hand experience using EHMs to communicate with patients. She saw high volumes of e-messages and clinician burnout, but also the ways e-messaging can be beneficial for patients. She paired her clinical experience with her research skills to better understand the challenges e-messaging caused for providers and patients and ways new models could be adopted.
What are the challenges of EHMs?
EHMs are an accessible way for people to reach a provider at any time of day. Most providers respond quickly within 24-48 hours of the message. But Bondurant says the time spent responding takes up a large portion of a clinician’s day, and can even take up time outside of work hours.
“We're having a lot of clinician burnout where people are not taking days off because they don't want to come back to their inbox,” Bondurant says.
Many health organizations have started charging for these messages. Many have followed a model that says if a message takes up more than five minutes of a clinician’s time, it is considered billable and can cost the patient around $50, depending on the clinic.
“We're having issues where patients are surprised by being charged for messages since many institutions include phrases like 'you may be charged for this message if…' which leaves unclear communication about what may be billed. Patients may not want to have those extra charges because it feels like something that should be included in their care,” she says.
These charges can create barriers for patients accessing care. Some people may be less likely to reach out for medical support if they cannot afford it. Bondurant says electronic messages can take away from the personal relationship between a patient and a provider.
“When there's more gatekeeping, people want to interact less,” she says. “And with the use of EHMs, there's more of a personal relationship, there's more direct and perceived access to your clinician. Then people want to continue that relationship and open up about all their healthcare issues and maybe other factors that are impacting their health.”
“If we put patients at the top of our goals, what does it really look like to interact with them through e-messaging, what should this service actually cost, and where does that come from?”
What are the solutions?
Bondurant says there is no one perfect solution. Instead, each health care system should choose a business model that works best for their patients and local community.
According to Bondurant’s research, these models might include offering a membership service to use EHM with a cost determined up front, accepting third-party payer reimbursement, or charging for a different preferred communication method.
Bondurant says finding a solution relies on a community pinpointing their largest problem.
“If [a clinic] has high turnover with their providers, they could look at a more sustainable approach with e-messages and inbox management, which may affect their turnover,” she says. “If they’re a small community where people would rather just pick up the phone rather than engage with e-messaging, maybe that ends up as a service they decide to charge for if it meets certain criteria.”
Bondurant’s preferred model is a service subscription model with a yearly fee.
“Every year you would have $40 that goes towards an e-message fee, and if you don't use it, it's refunded," she says. “I think the dream would be if we could reimburse health systems for EHMs that provide direct value to patients, such as those that prevent a hospitalization or an emergency room visit, but I think realistically, if clinicians were incentivized to handle a more complicated message, then proper reimbursement could mean a slightly bigger bonus for individuals.”
There doesn’t seem to be a perfect system that doesn’t put at least some cost on the patient, Bondurant says. The bottom line: there needs to be clearer communication about how much EHMs will cost patients; otherwise, people will leave the healthcare system entirely.
“I’m afraid of people not interacting with the healthcare system, and e-messaging is such a great way to reach folks at any stage of health,” she says. ”I wanted to bring more discussion to this area because I think price transparency is very important.”
