Guidelines For When and How E-Mail Can Work For You
Although face-to-face communication is the foundation of the physician-patient relationship, there are situations for which an office visit may not be necessary, and electronic mail (e-mail) communication may be more expedient.
However, e-mail should be used only to support direct interaction. Also, it should be used with considerable caution because along with great promise, e-mail potentially poses unique liability pitfalls.
The Benefits
E-mail can provide both physician and patient with several significant benefits.
- It’s fast, convenient and may improve patient management.
- It may encourage patient participation in care and strengthen physician-patient relationships.
- It provides the patient with a written account of physician information and advice that can be saved and referenced, thereby increasing patient understanding and compliance.
- It automatically provides the physician with a written record of communication (unlike a phone call).
- It allows the physician an opportunity to address patient issues in a calm and thoughtful setting as opposed to the, at times, hurried venue of an office visit.
- It allows the physician to conveniently attach reference documents and links to credible third-party information.
- It may improve patient and provider satisfaction.
Using E-mail
Prior to establishing e-mail communication with a patient, the physician should discuss the process with the patient and ask him or her to read and sign an online communications informed consent form. This form may cover a variety of issues, including instructions for using online communications, good communication etiquette, charges for using online communications, conditions of using online communications, access to online communications, risks of using online communications and, finally, the patient’s signature of acknowledgment and agreement. This information should become part of the legal documentation and medical record. In addition to a copy of the informed consent form, the physician may want to provide patients with a wallet-sized summary of the contract’s highlights. See Figure 1.
Appropriate and convenient uses for e-mail include scheduling appointments, releasing records (e.g., test results), providing follow-up instructions, explaining general medical information, answering billing questions, sending account reminders and refilling prescriptions.
Requests for new prescriptions should not be handled through e-mail. Instead, a good-faith examination of the patient should be performed in person to assess the medical necessity of any new prescription. Additionally, physicians should not answer clinical questions regarding a condition for which the patient has not been seen in the past six months.
The Risks
E-mail is no different from verbal communication in that physicians must avoid medical jargon and express themselves clearly, using terms the average person can understand. They should also be mindful of tone, and edit out any inappropriate or unprofessional comments.
Online communications, however, have created new challenges. The guidelines drafted by the eRisk Working Group for Healthcare, a consortium of national medical societies and medical professional liability carriers, and Medem, a network provider initially founded by the nation’s medical societies that serves the healthcare industry, offer physicians help in minimizing risk.
Specifically, the guidelines advise physicians to address the following issues:
- Security-Do not use unsecured e-mail. Choose a vendor that complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards by offering authentication and encryption-which standard e-mail services do not provide. Also, safeguard against unauthorized access to e-mail messages and computer hardware by using technologies such as automatic logouts and password protection.
- Authentication-Take reasonable steps to confirm the identity of e-mail correspondents and ensure that the information goes only to persons who are authorized to receive it.
- Confidentiality-Take reasonable steps to protect patients’ privacy by guarding against unauthorized use of their medical information.
- Unauthorized access-Establish procedures to help minimize the risk of unauthorized distribution of patient information.
- Physician-patient relationship-Weigh carefully any move to initiate a physician-patient relationship solely through online interaction, as this can increase liability exposure. Payment for online services may further increase that exposure.
- Medical records-Maintain a printed copy of all e-mail with patients regarding their ongoing medical care, and add this copy to the patients’ medical records. Inform patients of this policy.
- Licensing jurisdiction-Online interactions with patients are subject to state licensure requirements. Communicating online with a patient who lives outside of the state where you hold a license may increase your risk.
- Authoritative information-Make sure that information you provide via e-mail or on a medical practice Web site either comes directly from you, or from a credible source and has been reviewed by you. You are responsible for the information that you provide or make available to your patients online.
- Commercial information-Be careful of your wording in e-mail or on your Web site of an advertising, promotional or marketing nature. Such language may increase your liability, especially if it includes implicit guarantees, implied warranties, or misleading or deceptive claims.
In addition to these guidelines, the American Medical Association (AMA) has published extensive e-mail guidelines of its own at www.ama-assn.org/ama/pub/category/2386.html. A sampling of the AMA’s guidelines includes establishing a turnaround time for messages, configuring an automatic reply to acknowledge receipt of messages, and inserting an “electronic signature” at the end of all messages see Figure 2.
While few physicians currently use e-mail to communicate with patients-13 percent to 23 percent, according to recent studies-patients’ desire to e-mail their doctors appears to be growing. A recent survey by Jupiter Media Metrix (New York) found that 54 percent of patients would switch to a doctor who permits the use of e-mail to schedule appointments and renew prescriptions, as well as to ask treatment questions and check lab results.
Given patients’ increasing interest in online dialogue with their doctors, an increasing number of physicians may soon be moving from the hypothetical to the “how-to” of initiating e-mail interaction. The guidelines outlined in this article were drafted to address physicians’ practical concerns regarding security, confidentiality and liability risk. When those concerns are met, many more physicians may begin to explore the practical potential of e-mail with patients.
This article has been condensed from its original version. Reprinted with permission from The SCPIE Companies.
Figure 1
E-MAIL CONTRACT HIGHLIGHTS FOR PATIENTS
After patients have read and signed an e-mail contract, and it is filed in their records, the physician may want to provide a pocket-sized summary of the contract’s important points. Whether it’s a laminated card for the wallet or a sticker affixed to the back of the physician’s business card, an at-a-glance reference of the rules should help facilitate good e-mail communication.
Remember these e-mail guidelines:
- E-mail is not for emergencies! E-mail is not appropriate for urgent or emergency situations.
- Be concise. Come in for an appointment if the issue is too complex or sensitive to discuss via e-mail.
- Key in the topic (e.g., medical question, prescription renewal, appointment request) in the subject line.
- All e-mail will be filed in your record.
- Office staff may receive and read your messages.
Figure 2
John Smith MD
Neurosurgery
10 Main Street
Los Angeles, CA 90067
Phone: (310) 555-1212 Fax: (310) 555-4321
E-mail: [email protected]
- Call the office if the matter is urgent.
- Call 911 in an emergency or go to the ER!
- Please follow security guidelines.