DailyKaizen

I am double dipping here, as I reviewed this same paper in the context of patient centered health information technology elsewhere. However after the fact, I remembered this piece of the article that really struck me. The paper is a nice study of the use of electronic mail communication between physicians and patients that supports its use in practice. Excellent.

Look at this description of workflow:

Although our consent form indicated that e-mail responses would be sent within 72 hours, almost all physician responses were sent within 24 hours. In addition, many responses during regular business hours were sent within 2 hours. At the same time, our telephone triage system routed patient calls from patient to secretary to nurse to physician. The routing process could take several hours depending on the workload of each staff member. Our e-mail process bypassed the support staff, leaving the physician response time as the only bottleneck. The patients who used e-mail instead of telephone to communicate urgent concerns may have believed that the message would get through faster than through our telephone system. Thus, our efficient e-mail system may have emphasized inefficiencies in our telephone triage system; therefore, our short e-mail response times may have encouraged inappropriate communication of urgent concerns.

What I liked here was that the study, an objective evaluation of a “new” technology (e-mail), really became an evaluation of the established “gold standard” technology. The gold standard is shown to be (a) maybe not so efficient after all (b) not so valuable to patients who are paying for the service and (c) not so defining of what inappropriate communication of urgent concerns is. I found this last point especially interesting, because inappropriateness seems to be based upon inability to respond to the request quickly enough, not on the patient’s need. Since they discovered that “physician as the only bottleneck” is actually more efficient and results in a reduced response time, the definition of inappropriate communication changes. When we have a system that is transformed to respond at the speed expected by the patient, every communication of urgent concerns is appropriate, right?

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