Try to avoid sensitive material in your e-mail
Simple guidelines protect patients and staff
The SCPIE Companies, an insurer in Los Angeles, recently offered its own advice on reducing the risk of e-mail communication in health care. In addition to endorsing the eRisk guidelines, SCPIE says health care providers must be careful about when they choose to use e-mail.
The insurer says appropriate uses for e-mail include scheduling appointments, releasing records such as test results, providing follow-up instructions, explaining general medical information, answering billing questions, sending account reminders, and refilling prescriptions.
However, SCPIE cautions that requests for new prescriptions should not be handled through e-mail. Despite the convenience of e-mail, the patient should be examined in person to assess the medical necessity of any new prescription. Physicians also may consider prohibiting e-mail discussion of HIV test results, mental illness, alcohol or drug addiction, and workers’ compensation claims as well. SCPIE recommends that, at the very least, patients should be required to type "SENSITIVE" in the subject line of all e-mail pertaining to these issues. The insurer also advises physicians not to use e-mail for answering clinical questions regarding a condition for which the patient has not been seen in the past six months.
When a physician and patient want to use e-mail, the physician should "discuss the process with the patient and ask him or her to read and sign an on-line communications informed consent form. This form may cover a variety of issues, including instructions for using on-line communications, good communication etiquette, charges for using on-line communications, conditions of using on-line communications, access to on-line communications, risks of using on-line communications and, finally, the patient’s signature of acknowledgment and agreement. This information should become part of the legal documentation and medical record," it adds.
SCPIE also suggests that health care providers provide patients with a wallet-sized summary of the contract’s highlights. It could be a special laminated card, a sticker affixed to the doctor’s business card, or the information could be incorporated into the design of the business card. This is what the insurer recommends you put on the card:
- 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.
SCPIE’s e-mail advice can be found on-line at www.scpie.com. The American Medical Association (AMA) also has published guidelines for using e-mail. They can be found at www.ama-assn.org/ama/pub/category/2386.html. These are some points found in the AMA guidelines:
- As part of the informed consent process for establishing e-mail usage, tell patients who besides you processes messages during usual business hours, and who processes them when you are out sick or on vacation.
- Maintain a patient e-mail mailing list, but do not send group e-mails in which recipients’ names and/or e-mail addresses are visible.
- As with phone consultations, if the issue is too complex to discuss via e-mail, ask the patient to schedule an office visit.
- Set up an automatic reply to acknowledge receipt of patients’ e-mail messages.
- When you answer patients’ e-mail, ask them to acknowledge receiving and reading it.
- At the end of all e-mail messages, insert your "electronic signature," a pre-formatted standard block of text that contains your full name and contact information, as well as reminders about security and the importance of alternative forms of communication for emergencies. SCPIE offers this example of an appropriate electronic signature:
John Smith, MD
Dermatology
10 Main St.
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.
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