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Volume 1 Published - 14:00 UTC    08:00 EST    24-APR-2000      
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Back To Vidyya Using Electronic Mail For Patient Communication

Do's & Don'ts

E-mail can connect health professionals with patients, thereby increasing access to care, enhancing patient education, augmenting screening programs, and improving adherence to treatment plans. Barriers to access often arise simply because professionals can be difficult to reach. E-mail allows for the professional to answer inquiries as time becomes available and fosters continuous access for the patient to the health care system.

Used properly, e-mail may promote increased contact between patients and providers. By increasing opportunities for communication before and after visits, e-mail might help foster greater patient satisfaction. Unfortunately, empirical studies, and evidence-based indications and contraindications for e-mail's use in the medical arena are not well documented.

Several organizations have issued guidelines for practitioners to take into consideration when using e-mail in the medical workplace. Those guidelines generally look like the recommendations provided below:

Summary of Communication Guidelines

  • Establish turnaround time for messages. Do not use e-mail for urgent matters.

  • Inform patients about privacy issues. Patients should know:
    Who besides addressee processes messages
      - During addressee's usual business hours.
      - During addressee's vacation or illness.
    That message is to be included as part of the medical record.

  • Establish types of transactions (prescription refill, appointment scheduling, etc.) and sensitivity of subject matter (HIV, mental health, etc.) permitted over e-mail.

  • Instruct patients to put category of transaction in subject line of message for filtering: "prescription," "appointment," "medical advice," "billing question."

  • Request that patients put their name and patient identification number in the body of the message.

  • Configure automatic reply to acknowledge receipt of messages.

  • Print all messages, with replies and confirmation of receipt, and place in patient's paper chart.

  • Send a new message to inform patient of completion of request.

  • Request that patients use autoreply feature to acknowledge reading provider's message.

  • Maintain a mailing list of patients, but do not send group mailings where recipients are visible to each other. Use blind copy feature in software.

  • Avoid anger, sarcasm, harsh criticism, and libelous references to third parties in messages.

Medicolegal and Administrative Guidelines

  • Consider obtaining patient's informed consent for use of e-mail. Written forms should:
    - Itemize terms in Communication Guidelines.
    - Provide instructions for when and how to escalate to phone calls and office visits.
    - Describe security mechanisms in place.
    - Indemnify the health care institution for information loss due to technical failures.
    - Waive encryption requirement, if any, at patient's insistence.

  • Use password-protected screen savers for all desktop workstations in the office, hospital, and at home.

  • Never forward patient-identifiable information to a third party without the patient's express permission.

  • Never use patient's e-mail address in a marketing scheme.

  • Do not share professional e-mail accounts with family members.

  • Use encryption for all messages when encryption technology becomes widely available, user-friendly, and practical.

  • Do not use unencrypted wireless communications with patient-identifiable information.

  • Double-check all "To:" fields prior to sending messages.

  • Perform at least weekly backups of mail onto long-term storage. Define "long- term" as the term applicable to paper records.

  • Commit policy decisions to writing and electronic form.

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Editor: Susan K. Boyer, RN
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