The Physician’s Corner
Considering E-Mail Contact With Patients?
By Henry Tulgan, M.D., FACP
Not so long ago, the thought of
communicating with patients electronically would have caused most
physicians to shake their heads. Now it is estimated that up to one
third of medical practices use e-mail to communicate with their
patients, and more are investigating moving in this direction. However,
there are a number of medicolegal, federal and state laws to review
before taking this step. To prevent medical malpractice and prevent
potential loss, the following concerns should be addressed.
Two of the most pressing areas for
physicians to consider are missing a symptom or diagnosis due to lack of
an on-site presence, or missing an urgent patient message due to an
overburdened Inbox. Realistically, patients who have not been seen
directly in a practice setting for lengthy periods are not appropriate
candidates for an online consultation. A personal visit should be
scheduled thus allowing for follow-up communications via email. This
will clearly demonstrate an enhancement of the patient’s
relationship with you and will reduce your potential
liability.
At the Federal level, compliance
with HIPAA privacy and security requirements should be applied to your
practice regarding limiting employee(s) access to specific programs of
an electronic system or patient data base. HIPPA suggests the use
of encrypted messages, but there currently remains a dearth of
parameters as to what are considered best practices. Many states
also have confidentiality and security legislation under consideration
pertinent to electronic medical records. Therefore, practices
should conduct a risk-benefit analysis to assure that the benefit of
patient communications via e-mail clearly outweighs the amount of
risk. If you decide to use e-mail for patient contact, you should
develop strict policies and procedures for its use including defining
who has access to the system and who does not.
Considered low-risk is the use of
e-mail for appointment scheduling, for routine prescription refills and
for reporting of customary test results. However, revealing
complicated or complex results, especially if they are serious and/or
time sensitive must be dealt with more directly.
Attorneys and others with internet
security expertise and experience offer some advice. The best and safest
practice for physician offices is to set as policy the use of
encryption. Several commercial systems are available for physician
offices. Another option is to use a secure communication portal. Both
ensure HIPPA compliance.
It is also strongly advised to
obtain in writing, a patient’s permission to communicate via email
to document that they have made the decision to voluntarily waive
privacy rules. This and all communication going forward, must be
included in some fashion in the permanent patient record.
While still in early stages,
several insurance carriers are embarking on pilot programs to compensate
physicians who use Internet sites for “virtual house calls.”
As current and future generations of patients and physicians are
computer literate and as systems become more sophisticated, it is very
likely that electronic communications will be commonplace in physician
practices. However, the American Medical Association cautions that this
mode of patient contact should not replace appropriate face to face
interactions, the tried and true foundation of the doctor-patient
relationship.
Risk Management Strategies
-
Outline permissable uses for
using email in your practice, (e.g. administrative uses such as
scheduling).
-
Have a written email policy to
clarify what patients can expect from physician-patient electronic
communication.
-
Implement a system in your
practice which includes written physician-patient communication
guidelines.
-
Have patients sign an informed
consent form on their use of Internet and email services with your
practice.
-
Have all patient emails sent
through a secure communication portal, encrypt outgoing email or address
security concerns in your risk management profile.
-
Do not answer time-sensitive or
medically urgent patient questions via email. Choose direct
communication and document thed interaction.
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