Technology has advanced communication in many fields, including medicine. The potential advantages (and disadvantages) of quicker communication, education of patients and potentially improved patient satisfaction have increased patient and some physicians’ interest in e-mail interactions. Unique problems like protecting confidentiality, non-secure modes of conduct, and the potential creation of patient-physician relationships without direct contact make many physicians hesitant to use the technology. Legal, ethical, and professional guidelines do not change regardless of the communication technique, and any email communication should be treated the same as any documentation in the medical record.
Recent studies have shown approximately 15% of physicians connect with patients online, with almost 7% using email routinely. Higher percentages of physician-patient electronic communication are seen if electronic medical records are utilized. Interactions that don’t allow voice cues, body language to be observed, or messages that may be viewed out of context can increase liability risks.
To help mitigate risk, it is important to have a specific policy and procedure for email. This should detail the specific situations email with patients are appropriate as well as specifying who may contact patients.
A signed and dated consent for email should be in the patients chart as well as a copy given to the patient with appropriate documentation of discussion in the medical record. Documentation of the patient’s permission to forward identifiable medical information to third parties should be recorded.
The following suggestions can help to reduce risk in email communication:
- Develop a policy & procedure to set guidelines for email communication
- Never say anything in an email you wouldn’t say in person
- Keep messages short & focused
- Don’t use abbreviations
- Only communicate with existing patients
- Only discuss existing conditions, DO NOT diagnose via email
- Only communicate with patients in the state of licensure
- Don’t answer unsolicited emails
- Check spam filters to assure emails are not misdirected
- Inform patients that emails on a “work” computer are subject to review by their employer
- Maintain confidentiality
- Don’t communicate “bad news” via email
- Inform the patient that this email will be part of their medical record
- Terminate email communication with patients that don’t adhere to guidelines
If a situation of email “tag” with multiple correspondences develops, either call the patient directly or recommend an office visit. DOCUMENT ALL STEPS in the chart. Remember that all online communication is discoverable and is not “deleted” from hard drives.
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