In the Internet age, surveys show fewer than one in three doctors nationwide engage in "e-visits" with their patients.
And in Brevard County, Fla., the number of physicians communicating electronically may be even lower, according to several tech-savvy doctors.
"I do believe this is the wave of the future, but we aren't there yet," said Dr. Samuel Del Rio, an obstetrician/gynecologist with Partners in Women's Health, owned by Wuesthoff Health System.
Privacy and access problems, liability issues and a lack of reimbursement for dispensing free medical advice lie behind an apparent resistance within the health-care industry to move more rapidly online with these doctor/patient e-relationships. Cost also can play a role, especially in a small practice.
"Physicians are slow to embrace new technology," said Dr. Jeffrey Greenspoon, orthopedic surgeon in Melbourne, who has been communicating with his patients by e-mail for almost a decade. "They are very resistant to change their way of doing things."
Also, Greenspoon said, "economics is a big hurdle," as insurers provide no reimbursement to doctors for their e-mail transactions, even though these communications often substitute for regular office visits.
Dr. Tim Laird, Health First family practice physician in Port St. John, says e-mail consultations with patients, which he has done for several years, are "well suited to simple questions" that may not justify an office visit, but still are of concern to a patient.
"There are a lot of times where you don't need to see the patient in front of you," he said, citing blood pressure readings as "a perfect use for e-mail."
Because patients can take these readings at home, he said, they are able to send the results online so he can determine whether to adjust their blood pressure medications.
Laird said e-mail also is good for sharing routine test results with patients.
Earlier this year, two major insurers, Cigna Corp. and Aetna Inc., expanded pilot programs that compensate physicians who use a secure Internet site to make virtual house calls with patients — a step, doctors say, is in the right direction.
The American Medical Association also recently issued guidelines for physician-patient electronic communications. The guidelines emphasize the need to draw patients into the process at the outset to avoid confusion, and stress that "new communication technologies must never replace" face-to-face time with patients.
Dr. David Hurwitz, clinical director of informatics at Health First, who also works part time as an internist at Omni Healthcare, said there is "huge potential" for doctors to improve communication with patients through e-mail.
But, like his colleagues, he cautions "it's got to be easy and seamless," or it will be a tough sell for many physicians, "especially if they are technophobic."
Most studies show patients don't abuse the privilege of having a direct electronic pipeline to their doctor, if it's available.
In 2007, for example, a University of Pittsburgh study, published in the journal Pediatrics, found that after following 121 families who e-mailed their doctors, 6 percent of e-mails were urgent, with the rest geared to more routine matters. And doctors in the study received most of the e-mails after business hours — about one a day — responding 57 percent faster than by telephone.
Another study by Kaiser Permanente last year found that patients who used the health-care provider's secure Web site were almost 10 percent less likely to schedule an office visit.
Results of the study, published in the American Journal of Managed Care, also found that patients made 14 percent fewer phone calls than those who did not use the online services. Greenspoon's experience supports such findings.
Over the years, the e-mail system has paid off, not only in terms of customer satisfaction, Greenspoon said, but also in making his office far more efficient.
In addition, privacy concerns have not materialized, "to the extent we can now use secure encryption," similar to that used in any credit card transaction.
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