Communicating with patients by e-mail

1. Communicating with patients by e-mail REST 5114: Introduction to Computing Instructors: Titus Schleyer, Heiko Spallek

2. E-mail is ... … somewhere between letter-writing and talking. … more spontaneous than letter-writing. … less private than postal mail or telephone calls. … asynchronous.

3. E-mail ... … creates a written record. … is useful for information a patient would have to remember. … is self-documenting. … is used by 113M Americans1. … is used by 8M Americans for communication with health professionals2. 1www.pewinternet.org/reports/chart.asp?img=Internet_Activities.htm 2www.pewinternet.org/reports/toc.asp?Report=95

4. The path of an e-mail message Really? computer computer dentist patient

5. 5-min in-class exercise • Draw/write what you think is the real path of an e-mail message on the 5x7 card provided. (Please write/draw legibly.) • (Tip: There may be multiple possibilities.) • Then, hand your card to your neighbor.

6. real The path of an e-mail message

7. When sending e-mail … … double-check the “To:” line. … assure that the recipient can easily communicate with you or your designee. … use private (v. work) e-mail address for patient when possible. … inform patients about privacy issues. … use minimum necessary information (HIPAA).

8. General policies • Respect patient preferences for communication. • Do not use e-mail for urgent matters. • Provide an alternate communication channel. • Include messages as part of medical record. • Request “message received” receipt. • Request “message read” receipt.

9. General policies (cont.) • Establish type of transactions permitted over e-mail (e.g. appointment, prescription refill). • Instruct patients to put category of transaction (e.g. “billing question,” “medical advice” in subject line). • When sending group mailings, make sure recipients are not visible to each other.

10. General policies (cont.) • Avoid anger, sarcasm, harsh criticism, and libelous references to third parties in messages. • Do not share professional e-mail accounts with family members.

11. Mediocolegal guidelines • Obtain patient's informed consent for use of e-mail: • Itemize terms in Communication Guidelines. • Provide instructions for when and how to escalate to phone calls and office visits. • Indemnify the health care institution for information loss due technical failures. • Waive encryption requirement, if any, at patient's insistence.

12. Mediocolegal guidelines (cont.) • Never forward patient-identifiable information to a third party without the patient's express permission. • Print all messages, with replies and confirmation of receipt, and place in patient's paper chart. • Use encryption for all messages if available.

13. Mediocolegal guidelines (cont.) • Auto-Reply text: "Your message has been received by Dr. Leslie Smith. I will attempt to process your request- within one business day. If you need immediate assistance, please call Pat, my assistant, at 444-555-6666.“ • Use password-protected screen saver. • Perform at least weekly backups of e-mail.

14. In-class exercise • Read the e-mail message on the following slide and identify three issues/problems. • Record the issues/problems on your 5x7 card.

16. Further reading • Patt MR, Houston TK, Jenckes MW, Sands DZ, Ford DE. Doctors who are using e-mail with their patients: a qualitative exploration. J Med Internet Res. 2003 Apr-Jun;5(2):e9. • Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care? JAMA. 2003 Jul 9;290(2):259-64. • Ezenkwele UA, Sites FD, Shofer FS, Pritchett EN, Hollander JE. A randomized study of electronic mail versus telephone follow-up after emergency department visit. J Emerg Med. 2003 Feb;24(2):125-30.