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October 2010
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November 2010

Physicians Use E-mail With Patients Safely By Avoiding Misuse, Mishandling and Medicolegal Issues

Effective communication is a hallmark of patient satisfaction with their physician as well as with quality outcomes.  It is not surprising that surveys reveal more than 90% of patients desire to e-mail their doctors.  Physicians, however, are tentative about moving forward. In a 2009 survey by the Texas Medical Association, only about 20% of physicians reported the use of e-mail with their patients.

Those of us who do successfully use e-mail with patients know that we must be attentive to the risks involved to use e-mail safely. We also recognize that in order to use this technology efficiently we have to think about our work flow and be smart about redesigning it.  The risks of using e-mail with patients can be categorized into misuse, mishandling and medicolegal issues.

Misuses of physician-patient e-mail include:

  • seeking or providing new diagnoses/treatments
  • using e-mail with new patients with no previous face-to-face encounter
  • communicating on sensitive matters such as HIV, sexually transmitted infections, genetics and mental health
  • using e-mail for urgent or emergent issues
  • writing long, complex messages
  • using e-mail attachments with formats that patient’s computers may not be able open and read
  • forwarding e-mails from patients without their consent
  • advertising or promoting goods and products through e-mail

Mishandling issues with physician-patient e-mail include:

  • problems with e-mail triage or distribution within the office such as failure to adhere to established protocols or meet expected turn-around times for actions/replies
  • physicians using their personal e-mail accounts to send e-mail to patients
  • misunderstandings by patients/office staff regarding over who actually received, sent or replied to messages (authorship issues)

Medicolegal, privacy and security issues include:

  • failure to properly identify patients and verify e-mail addresses
  • privacy breaches
  • security problems with the e-mail system or related computer systems
  • not getting e-mail communications into the patient’s medical record
  • repudiation issues (i.e. patient denies sending or receiving an e-mail)
  • accountability issues
  • legal e-discovery issues
  • medical liability associated with diagnoses/treatment
  • failure to follow Texas Medical Board rules, HIPAA regulations or other on privacy/security regulations

These issues are certainly not insurmountable.  With an awareness and understanding of the rules, regulations and guidelines published by one’s state medical board, HIPAA, professional societies and other professional organizations such as the AMA, a physician can develop a set of policies and procedures to safely and efficiently use e-mail with their patients.  The procedures should include oversight mechanisms, adequate training of staff, adherence to privacy and security regulations, appropriate identification and authentication of each patient who consents to the use of e-mail and patient education to clarify what the physician will allow e-mail to be used for.  Patients should also be educated on how the office will manage e-mail messages and on what the expected turn-around times for replies will be.