Response: Re: Patient-Provider Communication: Does Electronic Messaging Reduce Incoming Telephone Calls?

To the Editor: We appreciate the thoughtful correspondence. Our article addresses the question of what would happen to phone call volume in the face of expanding electronic messaging. Although we offered multiple hypotheses about why we had unexpected findings, the reason for this outcome is unclear and deserves additional study. Dr. Bittner rightly points out that electronic communication with patients has many possible benefits. But the benefits of new health care interventions must be empirically tested and rigorously examined to best delineate their true value to care. In this case, we feel we have demonstrated that electronic portals have not yet been shown to be important in reducing other types of work, and clinics need to be aware of this. In addition, one must remember that the system of care that we design must be sustainable financially as well as emotionally. In a fee-for-service environment, clinicians are the driving force of reimbursement. This means that they may not have time to devote to portal communication if it takes them away from revenue-generating activities. In a capitation- or value-based model, there is the opportunity to build teams to serve patients in different ways. In this environment, financial resources may be available to support non–visit-based care, including both electronic and telephone communication by clinicians and staff. Our study demonstrated that there is not an obvious trade-off between electronic and telephone communication, and practices need to tailor their workflows and prepare their staff and providers to accommodate multiple media for communication from patients.