An E-mail Primer for Physicians and Their Practices

Be tech-savvy and risk aware

Patient requests to correspond with physicians via e-mail are on the upswing, and there's much to consider as you establish online policies for patient communication: HIPAA compliance, upgraded hardware and software, and the overall capabilities of your staff. You'll want to document procedures in a printed "policies and procedures" manual. As a risk-reduction measure, have legal counsel review the procedures before your practice adopts them.

Confidentiality Counts

A patient's written consent for e-mail correspondence is essential. Incorporate this consent into each patient's permanent medical record. Confirm that your patients are aware of the privacy measures you've instituted, including:

• Computer terminals positioned so that non-staff cannot view them.
• Automatic log-off and password-activated screen savers.
• An accessible audit trail of who read/viewed a message, including user ID, date and time.
• Secure archives, including off-site storage.
• E-mail accessibility for physicians when on-call or away from the office.

Patients must be assured that e-mail messages will not be forwarded beyond their treatment team, and that your e-mail address list will not be sold to others for marketing purposes.

Before you communicate with patients by e-mail:

• Establish a triage protocol for reading and forwarding e-mail to appropriate staff.
• Add patient identifiers, such as the patient's name and date of birth, to the log-in process.
• Develop timely response standards and include them in your policy.
• Adopt a tracking system using an e-mail program that confirms the patient's receipt of a transmission.
• Document transmission and receipt of all clinically relevant information exchanged between physician and patient, incorporate into the patient chart.
• Implement a plan to archive, retrieve and store messages.

Know Your Patients

As efficient as technology can be, keep in mind that face-to-face communication is best - a confused look cannot be discerned over e-mail. Because of this ambiguity, e-mail should be used only when a physician-patient relationship has already been established.

Another resource is ISMIE's seminar series, "Risk Management: An Essential Office Practice," which has a component devoted to e-mail processes and issues. (See calendar, Page 6.) The American Medical Association also has established guidelines for e-mail correspondence with patients; see www.ama-assn.org.