Email! Back when I still had a small private practice, I cared for many university employees. I gave them the option of contacting me by email.

Several patients took advantage of this offer. I found this style of communication excellent. I am available to email regularly. Email avoids the horrible game of “telephone tag”.

While email communication must have caveats – no emergencies, previously established patient – I believe the advantages outweigh the disadvantages. I am not alone.

Digital Rx: Take Two Aspirins and E-Mail Me in the Morning

Doctors may no longer make house calls, but they are answering patient e-mail messages – and being paid for it.

In a move to improve efficiency and control costs, health plans and medical groups around the country are now beginning to pay doctors to reply by e-mail, just as they pay for office visits. While some computer-literate doctors have been using e-mail to communicate informally with patients for years, most have never been paid for that service.

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Brian Settlemoir, 39, an accountant in Folsom, Calif., recently sent an e-mail message to his doctor at the Creekside Medical Group to ask if it was time to reduce the dosage of a medicine after his cholesterol level dropped. The prompt answer was “not yet.”

“I’m sitting at work,” Mr. Settlemoir said. “I’ve got e-mail open anyway. It’s much easier than calling and getting voice-mail prompts and sitting on hold. It’s very valuable to me.”

Blue Shield of California pays his doctor $25 for each online exchange, the same as it pays for an office visit. Some insurers pay a bit less for e-mailing, and patients in some health plans are charged a $5 or $10 co-payment that is billed to their credit card and relayed to the doctor.

For doctors, the convenience of online exchanges can be considerable. They say they can offer advice about postsurgical care, diet, changing a medication and other topics that can be handled safely and promptly without an office visit or a frustrating round of telephone tag. And surveys have shown that e-mail, by reducing the number of daily office visits, gives physicians more time to spend with patients who need to be seen face to face.

For patients, e-mail allows them to send their medical questions from home in the evening, without missing work and spending time in a doctor’s waiting room. In fact, many say exchanges in the more relaxed, conversational realm of e-mail make them feel closer to their doctors.

The patients can also use the e-mail connections, which they reach through secure Web sites, to get X-ray and test results and request prescription renewals. Doctors are not paid for these services, except in time saved in the office.

One company which helps physicians develop secure standard communications is RelayHealth

I am a big fan of this concept. If I were still in practice, I would purchase a Blackberry and register with a company like RelayHealth. Email communication is efficient, timesaving (for both patients and physicians) and probably cost-effective. I hope all insurers will understand this soon.

The American Medical Association has issued a temporary identification number for online visits in the association’s “current procedural terminology” code that doctors and hospitals use in sending bills. But Robert Mills, a spokesman, said the association was waiting for more data on how clinical messaging was being used before issuing code numbers like those for office examinations and follow-up visits that payers refer to in their schedules of fees. “All consumer surveys in the last several years show patients want to be able to communicate through e-mail or messaging,” said Dr. Thomas Handler, research director at the Gartner Group, the technology consulting firm. “The problem was, reimbursements for the doctors weren’t there.”

That is changing quickly. One pleased consumer, Dona Gapp, a schoolteacher in New York, who is expecting her first child in April, said she used e-mail to ask Dr. Richard U. Levine, her obstetrician at the Columbia University Medical Center, if certain vitamins and nonprescription medicines were safe for her.

“It was much easier to have access by e-mail,” she said. “When I had a chance to call, it was after 5 o’clock and he was not there.” He replied to her e-mail within hours, she said.

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