Pediatric Informatics: Computer Applications in Child Health (Health ...

316 R.S. Gerstle
23.6 E-Mail Scenarios (Hypothetical)
23.6.1 Behavior Problems and Practice Pamphlets
Matilda Rivera, mother to 3 year old Jose, e-mails you that she is having difficulty with his
negative behavior, refusing now to sit on the toilet and beginning to have more tantrums
when she doesn’t let him get his way. What should she do?
You remember that you had a similar question posed to you previously and found a good
document on the Internet that you modified. You saved your recommendations as a document
(negative behavior in 3 yr-old.doc) for possible future reuse. Reviewing that document,
you make some minor edits and personalize it for Jose’s situation. You’ve also included a
couple of web site URLs which you re-review to make sure they are still accurate, to provide
Jose’s mother with additional information about typical 3 yr old behavior problems. You
attach the document to the reply to the original e-mail she sent to you, and encourage
Jose’s mother to try your suggestions, but to come to the office if things don’t improve over
the next month’s time. Your response is saved in Jose’s medical record (either by printing
out the reply and document, or by saving a copy of the e-mail question and response to the
electronic medical record).
This is an example of incorporating e-mail and electronic documents into the office
practice. It is a nonemergency problem, and no harm will result from a short delay.
For recurring or common issues, recommendations may be “reused.” Reference and
links to online resources will provide written information that may be consulted or
discussed at a later visit.
Patients will use e-mail for a variety of health care matters. A study of e-mail
content from two large academic medical practices 9 found the following distribution
of e-mail use (Table 23.1):
Table 23.1 Patient e-mail content from two
large academic practices
Message content %
Information updates to the physician 41.4
Prescription renewal requests 24.2
Health questions 13.2
Messages about medical tests 10.9
Referral requests 8.8
Appointment requests 5.4
Information seeking (directions, office
hours, etc.)
4.8
Billing questions 0.3
Other (thank you, apologies,
non-medical, study related)
8.8
For pediatric practices, 80% of patients in a pediatric practice expressed interest
in using email for six functions: 10
Schedule an appointment
Give/get test results
Refill prescriptions