As a practicing obstetrician and gynecologist in San Francisco since 1995, I realized very early in my career that I would not be able to handle my hectic schedule if I didn't introduce efficiencies into my practice. In that first year, it felt like all I did was play phone tag with my patients.

Luckily for me, the Internet and e-mail were taking root.
I decided that my first efficiency would be to switch to e-mail communication with patients. After all, weren't they just as busy as me? Weren't they as tired of waiting for the phone to ring as me?

At first, my standard AOL email was fine (this was pre-HIPAA). Unfortunately, this meant patient messages sometimes were lost among personal e-mail and spam. This was better than phone tag, but clearly not the best solution.

In 1999, I was introduced to Medem (stands for "medical empowerment"), a San Francisco-based company founded by the American Medical Association and several national medical specialty societies to provide a secure portal for electronic communication between physicians and patients. One of the most well-known, well-established companies of its kind, Medem hosts tens of thousands of physician sites, from solo practices to large academic centers. Allied with various physician professional organizations and nearly 50 state and specialty medical societies, including the American College of Obstetricians and Gynecologists (ACOG), Medem's iHealth service offers many practice efficiency benefits.

First and most obvious is secure messaging. While for some this creates a fear of being inundated with messages, I have not found this to be the case at all. In fact, most of our patient's questions are simple, and can be quickly answered in a minute or less. The same question takes much longer by phone, with the inevitable, "While I have you on the line..."

As an example, I answer 10 questions with secure messaging in the time it takes me to answer a single question by phone. I estimate that I have saved at least one hour per day in phone calls. Patients really appreciate the quick responses, and are more than willing to come in for a visit if their problem is too complex to be handled online. With my schedule, that means I am getting back at least 16 to 20 hours each month!

Since iHealth has saved me an enormous amount of time and frustration, I choose not to charge for it. The major health plans continue to explore coverage issues for online consultations, and as each health plan makes a final decision, Brown & Toland will consider appropriate processes for authorizations, claims and physician compensation for these services.

Other features of iHealth's online services, which have greatly improved my practice efficiency, are appointment requests, prescription refills, lab results, and billing questions.

Patients also may document their medical history and pre-register for appointments by filling out an iHealthRecord. In fact, hundreds of thousands of patients have already done so. With patient consent, providers may access and view this information from their Web site and even populate it, improving documentation and potentially qualifying for pay-for-performance payments.

Another remarkable feature of the iHealthRecord are iHealthAlerts, which are online drug alerts that patients receive by secure e-mail in the event that drugs in their records become the subject of a patient safety alert or drug recall notification.

Incidentally, Medem also provides network support for the only physician-focused, online drug recall service, the Health Care Notification Network (HCNN). Like the iHealthRecord, which is free for patients, the HCNN is free for both physicians and physician assistants.

Finally, practices also may post links to medical articles, various registrations forms, patient instructions, care management courses, and education programs, all from Medem's award-winning medical library of more than 6,000 peer-reviewed resources.

Posting links has been a huge timesaver, and saves me from having to repeat the same explanation for every patient with an abnormal result. I simply post common reasons for abnormal results with instructions to schedule appropriate follow up. The best part is that the articles come from trusted societies like ACOG, so I know the information is safe, accurate and up-to-date.

With the recent passage of the American Recovery and Reinvestment Act, which allocates nearly $20 billion for physicians to move care online, the option of standing on the sidelines is long gone. Thousands of dollars in annual physician incentives kick in starting in 2011 (and will become penalties after 2015). This leaves very little time to move your practice online.

The beauty of iHealth is that it gets your practice securely online immediately. For Brown & Toland providers, the service is free. Otherwise, an annual subscription costs $595 a year.

In other words, a whole lot less than you are already paying the telephone company to play phone tag.