Email Is Old

Physicians providing email communication with patients is growing slowly. Recent reports state that “only” 25% of physicians in 2006 are offering email services. This is remarkable because the percentage five years ago was closer to 5%. In the realm of diffusion of innovations, around 27-28% penetration if often a “tipping point” where an innovation cannot be stopped and will sweep society. I believe this will happen with email and physicians, most likely through secure web portals.

I began giving my email to patients in 1997, mostly as a convenience and to avoid the terrible telephone system where I worked. After about a year I realized that I had discovered an important innovation for patient care, a new platform of communication which enhanced the physician-patient relationship. I joined with other early physician users of email and began speaking and writing about it, studying the early data on its use. Five years ago I received a lot of push-back from physicians. Email would be an uncontrolled extra burden that would not be good for patient care. Now, most physicians see it as an inevitable part of the internet age.

My thinking that email with patients is on the cutting edge of health care innovation was dampened recently when my 28 year old son told me, “Dad, email is old”. He went on to explain that email was the past, not the future. Live video is the future.

My son is living proof of this. His serious girlfriend recently moved to Indiana University to pursue a PhD in English. He is a graduate student in film studies at San Diego State. Everyday they communicate with each other live and “in person” using their Apple computers with a built-in video camera. Three times a week they have dinner dates. My son sits at his computer, nicely dressed from the waist up, with a nice dinner in front of him. His girlfriend does the same from Bloomington, Indiana. At my son’s apartment she is larger than life on his monitor, sharing dinner and close conversation. The images are as clear as a CNN interview from multiple locations.

Imagine the health care applications! Video visits and providing remote care, having the advantage of all the senses except touch. A common criticism of email is that it is typed text, with no voice, no visual, and no emotion. Information is obtained by email, but the limitations are enormous. Video becomes the next best thing to being there, and makes email seem obsolete indeed! Imagine caring for patient in their homes by video or even in remote areas such as oversees. I can easily see the Mayo Clinic or the Cleveland Clinic expanding their reach around the world. Why not us in San Diego! Pacific Rim, here we are, ready to care for you!

When you are living through history it is easy not to appreciate the magnitude of some historic events. As I write this, the big business story of the week is Google buying YouTube for 1.65 billion dollars. Why did they do that? The simple answer they gave was, the future of the internet is video. Notice on Google home page the icon for video now shows up next to images. You may think I have gone off the deep end, but I think the Google purchase of YouTube was a major historical step for the internet age, and will also have enormous implications for health care.

Just imagine what video means for our medical records! Not just static information anymore. Want to document the progression of someone’s Parkinson disease? Watch the videos of the patient’s gait or arm movements at rest and while eating. With Alzheimer’s patients, take a look at the behavior which happens at sundown. Look at the child’s behavior, is it really ADHD or a need to get out more and play. Life, documented, becomes a series of video clips. A camera records our office visits. The applications are endless and mind boggling. Those moving pictures in the Harry Potter stories become real after all.

So, fellow physicians get those electronic health records with a secure communication portal and start emailing with patients. That will be just the beginning of the future of online and remote communication. Evisits, which of course must be financed as part of care, have an incredibly exciting future. Email may be old to the new generation of adults, but it is finally coming to health care.

Someday soon, we will have continuous access to our patient’s life situation, at home and at work. This may sound like an Orwellian big brother, but not if it is patient driven. How limited we are today by only seeing our patients in the office. Caring for patients the 21st century way is just beginning. One hundred years ago it was horse and buggy. Someday, our great-grandchildren will look at 2006 office practice the same way. Email is only a primitive beginning. Email is old.