If it’s votes for a politician, 55 percent is almost a landslide. But when a recent study by Deloitte suggested that many Americans would like to be able to email their doctors, a reporter asked me if I was surprised that it wasn’t more.

The numbers in the Deloitte survey didn’t surprise me for two reasons:

• There have been several surveys that have shown similar numbers.
• Some people view healthcare differently than other services. Some physicians that have offered secure messaging find they are lucky to get half of their patients to sign up to use it, even if they encourage patients to do so. Others that aren’t as quite as aggressive in encouraging the use of such tools find registration rates very low, even in single digits as a percentage of patient population.

Another thing that I find interesting is this:  Some healthcare entities offer both online appointment requests (fill out a form requesting several possible days and times, and clinic staff gets back with you to find a match) and direct scheduling (like booking an airline seat where you see the available openings, pick the one you want and book it).  But guess which one gets more use when patients have the choice?  The appointment request!  The reason is a matter of speculation, but the theory is that patients lack the confidence to specify what kind of appointment they need, etc., so they use the request form instead. Go figure.

But I’d argue that all of that is irrelevant. The list of healthcare providers offering the kinds of services mentioned in the article is long and growing. So, those healthcare entities that fail to offer these services do so at their peril. Here’s why:

• These tools attract new patients and increase loyalty of existing patients. Maybe not all of them, but more than enough for a good ROI.  And staff find it easier to handle non-emergency requests this way. No phone tag, no trouble with accents, not having to write down what the patient is saying, and they can handle these inquiries when they have a few minutes (the phone always rings when you are five deep at the registration desk). Not to mention any activity that is entirely automated, like direct scheduling, pre-registration, bill payment, etc.
• If they did the survey among young adults, or even women in their child-bearing years, the numbers would be quite different. As the population ages, patients will have never known a world without the Internet.  If you wait until that critical mass hits middle age, most of your competition will already be offering these services, and you’ll be left behind.

Increasingly patients are coming to expect these kinds of services. Can you imagine an airline that didn’t allow online reservations, payment and check-in? They’d be out of business very quickly. I figure if I can do all my bills, banking, taxes, loan and insurance applications online, maybe even find a spouse online (I know people how have done it and are happy with the result), why can’t I handle non-urgent matters with my healthcare provider the same way?  For an increasing number of patients, they can!

The difference is the number of people who can see it. That’s why I was interested in the news from NewYork-Presbyterian. They are piloting a project that will feed a patient’s medical record into Microsoft’s Health Vault, while still giving the patient control to add or edit content. It’s called MyNYP.

It’s a step towards a complete online medical record, which in my view teeters between a vision and a hallucination.

The concept isn’t new or unheard of, but it remains rare, and largely incomplete. Many health providers using Epic’s MyChart expose portions of the medical record to their patients. And some hospitals and health systems offer some form of a personal health record, where the patient enters his/her own data, with the option of sharing it with their doctor.

But the holy grail of a truly complete online health record remains elusive, for a number of reasons:

• It’s a rare patient that gets care from only a single hospital or health system, and rarer still who has received a lifetime of care from a single entity. If even one is not feeding their online record, it’s incomplete.
• Uneven use of EMRs by some doctors makes even the best tools shaky at best. I had a doctor who had full access to a very robust EMR, but his failure to consult it caused him to prescribe a medication three times that caused a potentially life-threatening complication the first time.
• Patient-entered data is fraught with error. Some patients will claim an allergy to asparagus, when they just don’t like the taste. Others forget key elements or just have them wrong. Yet others don’t want to admit that they smoke, or never exercise.

Still, you have to applaud what NYP is trying. It’s a big improvement, but the picture it provides will still be incomplete. Step at a time, though, and this is a good step.