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The Electronic House Call
We read with interest the article by Drs Østbye and Hurlen regarding the electronic house call.1 We agree that the possibility of providing health care through new modes of electronic communication is exciting and has staggering implications. However, the authors focus on future possibilities while being seemingly unaware of current applications of electronic care provision between patients and physicians. Consequently, their focus on telemedicine, with their definition of live 2-way audio, 2-way video transmission, may lead to confusion about the use of store-and-forward electronic communication, a medium to which they themselves refer. Communication between patients and the health care system via electronic mail seems to have notable potential as a strategy for providing health care. Recent evidence in academic2 and mainstream3 publications has suggested that this is not only a viable provision mechanism but also seems to be appealing to patients. Moreover, the American Medical Informatics Association has created an interest group on patient-physician communication via electronic mail. Thus, we agree with the authors' look to the future of providing health care1 but are aware, as are all practitioners who receive electronic mail from their patients, that part of that future is already here.
Arch G. Mainous III, PhD;
Richard A. Neill, MD
Kentucky Clinic
University of Kentucky
Lexington
1. Østbye T, Hurlen P. The electronic house call: consequences of telemedicine consultations for physicians, patients and society. Arch Fam Med. 1997;6:266-271.
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2. Neill RA, Mainous III AG, Clark JR, Hagen MD. The utility of electronic mail as a medium for patient-physician communication. Arch Fam Med. 1994;3:268-271.
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3. Rubin R. Can't reach your doctor? try e-mail. US News & World Report. February 13, 1995:82-83.
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In reply
We would like to thank Drs Mainous and Neill for commenting on our article.1
As stated in the article, the primary focus of our discussion was the potential of using combined video and audio equipment for communication between physicians and patients. We also used the term "store-and-forward system" to indicate temporary storage of video messages, or at least still pictures (the way it is done in radiology), rather than simple, text-based electronic mail.
Video communication is more immediate than text-based electronic mail because people actually talk with those at the other end of the line. Although there is an element of interactivity in electronic mail as well, there is still the feeling that people are simply leaving messages for each other; this usually leaves the communication less personal.
We appreciate that there may be several niches for patient-physician communication using text-based electronic mail, especially in the short-term. It is a reasonable choice for short, simple messages and may provide a useful supplement to regular face-to-face consultations (and to video consulations).
However, text-based electronic mail remains a medium with a "narrow bandwidth" and is still limited by the patient's (and physician's!) keyboarding skills. We, therefore, believe that communication using sound and video has a greater potential and is likely to become more important in the future.
Truls Østbye, MD, MPH
University of Western Ontario
London
Petter Hurlen, MD, MSc
Siemens Health Services
Oslo, Norway
1. Østbye T, Hurlen P. The electronic house call: consequences of telemedicine consultations for physicians, patients, and society. Arch Fam Med. 1997;6:266-271.
Arch Fam Med. 1998;7:210.
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