Fears of patient abuse of e-mail not realised

Dr Paul C. Tang, Chief Medical Information Officer at the Paolo Alto Medical Foundation (PAMF), California, said that there had been concern about introducing a facility on the foundation’s web service, PAMF Online, which offered unlimited, 24/7 messaging with doctors and nurses for $60 a year. 

“It turns out patients did not abuse it.  They switched from phone and visits to this method,” he said.

Speaking at a conference session on patient safety and the elimination of medical errors, Dr Tang said the service was part of PAMF’s pursuit of “continuous healing relationships” with patients – a principle of 21st century healthcare set out by the US Institute of Medicine.

Patients can use the service to book appointments, receive advice from doctors and send notes about progress. Over 15,000 users have signed up and 23% are over 60 years old, challenging the assumption that only younger age groups use online services.

Dr Tang said over 90% of doctors with more than 100 patients registered to use the messaging service had said in a recent survey that they were satisfied with the system.

In a wide ranging review of technology’s role in the reduction of error, he looked at research into the situations that create a danger of medical records. He concluded that information at the point of care was the key factor in ensuring patient safety.

Dr Tang characterised the different forms of decision support as:

• “Watch out”.  Messages that alert staff to potential problems such as drug allergies or interactions.


• “Health reminders”. Prompts to take preventive steps such as flu vaccination.


• “Excuse me”. Warnings and alerts about abnormal laboratory results or worrisome trends in vital signs.  Dr Tang said this was the kind of information that tended to get missed at hand-off where error rates increase.


• “Would you consider…? Messages offering alternative treatment based on best practice.  For example, a doctor can be prompted to prescribe a newer drug with fewer side effects or a lower, but still effective, dose of a particularly costly drug.


• “Evidence shows”. Reinforcements of clinical guidelines.