Reporting on health and quality of life in South LA

Many low-income patients want to email their doctors; few actually do, can

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Around seven in 10 low-income patients say they're interested in communicating electronically with their health providers – but only 19 percent actually do.

The disparity is highlighted in a recent study appearing in the Journal of General Internal Medicine.

"A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers," wrote the authors. "This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging."

Nina Vaccaro, the executive director of the Southside Coalition of Community Health Clinics, says that tide is changing. She pointed to the eight member clinics in the coalition.

"Right now, most clinics have an electronic health record, but they have not opened up access to their patient portals," she said. A patient portal is an online system where a patient can log on and, through a secured system, send an email to any one of her or his health providers. Once that's in place, southside clinics will be in a much better position to fill the unmet interest highlighted by the study.

But for the most part, that sort of infrastructure isn't yet present in the Southside Coalition clinics. Vaccaro said a recent workflow analysis of how South L.A. patients reach out to their doctors was telling.

"Ninety percent of the time or more the patient will have to call," she said. "Either they leave a message with the physician's assistant or they have some other process set up in the clinic where, say, a nurse manager takes all incoming calls and relays them to the primary care provider it relates to."

According to the study's senior author, Dr. Urmimala Sarkar, that's got to change if South L.A. clinics are to stay current.

"Electronic health-related communication is becoming the standard of care in well-resourced settings, and should be implemented and supported in resource poor settings," she said in a statement.

The study's lead author, Dr. Adam Schickedanz, added that safety-net patients "want to be part of the health information technology revolution." The question that remains: Will they get an opportunity?

In the South L.A. clinics, it looks like they will. Vaccaro said one clinic, T.H.E. Clinic, is ahead of the game.

"They have opened up their patient portal," she said. "So if you were a patient at T.H.E. Clinic, you actually do have a secure way to contact your doctor."

That security is important, especially given the Health Insurance Portability and Accountability Act of 1996. Under HIPAA, providers can correspond electronically with their patients, "provided they apply reasonable safeguards when doing so." While the use of unencrypted email communication isn't prohibited by HIPAA, it does say providers using unsecured electronic correspondence should take as many safeguards as possible to ensure the confidentiality of medical records or information isn't threatened or violated.

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