E-Mail, Your Patients, and You

As more patients attempt to e-mail their physicians, I am increasingly asked if this is a good idea. The answer is, as with most things, it depends.

Although this is not a particularly new issue, and many patients are enthusiastic about the prospect of communicating with their physicians online, most physicians remain reluctant to do so. Aside from the obvious privacy issues, many balk at one more unreimbursed demand on their time. While I share those concerns, there also are real benefits to be gained from online communication, among them increased practice efficiency for you, and increased quality of care and satisfaction for your patients.

I started giving one of my e-mail addresses to selected patients several years ago as an experiment, hoping to take some pressure off of our overloaded telephone system. The patients were grateful for simplified and more direct access to me, and I appreciated the decline in phone messages and interruptions while I was seeing patients. I also noticed a welcome decrease in those frustrating, unnecessary follow-up visits—you know, “The rash is completely gone, but you told me to come back. …”

Of course, the experiment has yielded some problems. Privacy is always a concern, although no patients have yet raised the issue. Also, some patients don't always give me the information I need, and often include a lot of stuff I don't need. And occasionally, despite my best efforts to educate them on appropriate e-mail use, I receive requests for refills or treatment I cannot provide without an office visit.

In general, however, I have found that the advantages for everyone involved (not least my nurses and receptionists) far outweigh the problems. And now, newer technologies such as encrypted e-mail, Web-based messaging, and integrated online communication systems should go a long way toward assuaging privacy concerns.

Contrary to popular belief, ordinary unencrypted e-mail does not necessarily violate the Health Insurance Portability and Accountability Act (HIPAA). As I've noted many times, HIPAA allows you to handle medical information in just about any way you wish, as long as patients are informed of what you are doing and accept any risks of breach of privacy associated with it. As long as the Notice of Privacy Practices that you distribute to patients explains your e-mail policies, and each e-mail includes a standard confidentiality disclaimer, you will be HIPAA compliant.

Still, if the lack of encryption and other privacy safeguards makes you (or your patients) uncomfortable, encryption software can be added to your practice's e-mail system. Kryptiq (www.kryptiq.comwww.sigaba.comwww.tumbleweed.comwww.zixcorp.com

But rather than simply encrypting their e-mail, increasing numbers of physicians are opting for Web-based messaging. Patients enter your Web site and send a message using an electronic template that you design. You (or a designated staffer) will be notified by regular e-mail when messages are received, and you can post a reply on a page that can only be accessed by the patient. Besides enhanced privacy and security, the big advantage of Web messaging is the ability to use templates, which ensure that messages include the information you need and minimize extraneous chatter. And you can design separate templates for nurses and receptionists so every message need not go through you.

Web-based messaging services can be freestanding or incorporated into existing secure Web sites. Medem (www.medem.comwww.medfusion.netwww.relayhealth.com

To really do it right, though, you need to integrate your messaging service into your medical records. If you are looking to add an electronic medical record (EMR) system to your office, add Web messaging to your list of essential features.

Last year I discussed the basic rules to keep in mind when shopping for an EMR system. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com

Naturally, this is not only your best option over the long haul, but also the most expensive. However, all of us not planning to retire in the next decade will be looking into EMR whether we want to or not. So it behooves us to make sure efficient patient communication capabilities are an integral part of any system we choose.

As more patients attempt to e-mail their physicians, I am increasingly asked if this is a good idea. The answer is, as with most things, it depends.

Although this is not a particularly new issue, and many patients are enthusiastic about the prospect of communicating with their physicians online, most physicians remain reluctant to do so. Aside from the obvious privacy issues, many balk at one more unreimbursed demand on their time. While I share those concerns, there also are real benefits to be gained from online communication, among them increased practice efficiency for you, and increased quality of care and satisfaction for your patients.

I started giving one of my e-mail addresses to selected patients several years ago as an experiment, hoping to take some pressure off of our overloaded telephone system. The patients were grateful for simplified and more direct access to me, and I appreciated the decline in phone messages and interruptions while I was seeing patients. I also noticed a welcome decrease in those frustrating, unnecessary follow-up visits—you know, “The rash is completely gone, but you told me to come back. …”

Of course, the experiment has yielded some problems. Privacy is always a concern, although no patients have yet raised the issue. Also, some patients don't always give me the information I need, and often include a lot of stuff I don't need. And occasionally, despite my best efforts to educate them on appropriate e-mail use, I receive requests for refills or treatment I cannot provide without an office visit.

In general, however, I have found that the advantages for everyone involved (not least my nurses and receptionists) far outweigh the problems. And now, newer technologies such as encrypted e-mail, Web-based messaging, and integrated online communication systems should go a long way toward assuaging privacy concerns.

Contrary to popular belief, ordinary unencrypted e-mail does not necessarily violate the Health Insurance Portability and Accountability Act (HIPAA). As I've noted many times, HIPAA allows you to handle medical information in just about any way you wish, as long as patients are informed of what you are doing and accept any risks of breach of privacy associated with it. As long as the Notice of Privacy Practices that you distribute to patients explains your e-mail policies, and each e-mail includes a standard confidentiality disclaimer, you will be HIPAA compliant.

Still, if the lack of encryption and other privacy safeguards makes you (or your patients) uncomfortable, encryption software can be added to your practice's e-mail system. Kryptiq (www.kryptiq.comwww.sigaba.comwww.tumbleweed.comwww.zixcorp.com

But rather than simply encrypting their e-mail, increasing numbers of physicians are opting for Web-based messaging. Patients enter your Web site and send a message using an electronic template that you design. You (or a designated staffer) will be notified by regular e-mail when messages are received, and you can post a reply on a page that can only be accessed by the patient. Besides enhanced privacy and security, the big advantage of Web messaging is the ability to use templates, which ensure that messages include the information you need and minimize extraneous chatter. And you can design separate templates for nurses and receptionists so every message need not go through you.

Web-based messaging services can be freestanding or incorporated into existing secure Web sites. Medem (www.medem.comwww.medfusion.netwww.relayhealth.com

To really do it right, though, you need to integrate your messaging service into your medical records. If you are looking to add an electronic medical record (EMR) system to your office, add Web messaging to your list of essential features.

Last year I discussed the basic rules to keep in mind when shopping for an EMR system. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com

Naturally, this is not only your best option over the long haul, but also the most expensive. However, all of us not planning to retire in the next decade will be looking into EMR whether we want to or not. So it behooves us to make sure efficient patient communication capabilities are an integral part of any system we choose.

As more patients attempt to e-mail their physicians, I am increasingly asked if this is a good idea. The answer is, as with most things, it depends.

Although this is not a particularly new issue, and many patients are enthusiastic about the prospect of communicating with their physicians online, most physicians remain reluctant to do so. Aside from the obvious privacy issues, many balk at one more unreimbursed demand on their time. While I share those concerns, there also are real benefits to be gained from online communication, among them increased practice efficiency for you, and increased quality of care and satisfaction for your patients.

I started giving one of my e-mail addresses to selected patients several years ago as an experiment, hoping to take some pressure off of our overloaded telephone system. The patients were grateful for simplified and more direct access to me, and I appreciated the decline in phone messages and interruptions while I was seeing patients. I also noticed a welcome decrease in those frustrating, unnecessary follow-up visits—you know, “The rash is completely gone, but you told me to come back. …”

Of course, the experiment has yielded some problems. Privacy is always a concern, although no patients have yet raised the issue. Also, some patients don't always give me the information I need, and often include a lot of stuff I don't need. And occasionally, despite my best efforts to educate them on appropriate e-mail use, I receive requests for refills or treatment I cannot provide without an office visit.

In general, however, I have found that the advantages for everyone involved (not least my nurses and receptionists) far outweigh the problems. And now, newer technologies such as encrypted e-mail, Web-based messaging, and integrated online communication systems should go a long way toward assuaging privacy concerns.

Contrary to popular belief, ordinary unencrypted e-mail does not necessarily violate the Health Insurance Portability and Accountability Act (HIPAA). As I've noted many times, HIPAA allows you to handle medical information in just about any way you wish, as long as patients are informed of what you are doing and accept any risks of breach of privacy associated with it. As long as the Notice of Privacy Practices that you distribute to patients explains your e-mail policies, and each e-mail includes a standard confidentiality disclaimer, you will be HIPAA compliant.

Still, if the lack of encryption and other privacy safeguards makes you (or your patients) uncomfortable, encryption software can be added to your practice's e-mail system. Kryptiq (www.kryptiq.comwww.sigaba.comwww.tumbleweed.comwww.zixcorp.com

But rather than simply encrypting their e-mail, increasing numbers of physicians are opting for Web-based messaging. Patients enter your Web site and send a message using an electronic template that you design. You (or a designated staffer) will be notified by regular e-mail when messages are received, and you can post a reply on a page that can only be accessed by the patient. Besides enhanced privacy and security, the big advantage of Web messaging is the ability to use templates, which ensure that messages include the information you need and minimize extraneous chatter. And you can design separate templates for nurses and receptionists so every message need not go through you.

Web-based messaging services can be freestanding or incorporated into existing secure Web sites. Medem (www.medem.comwww.medfusion.netwww.relayhealth.com

To really do it right, though, you need to integrate your messaging service into your medical records. If you are looking to add an electronic medical record (EMR) system to your office, add Web messaging to your list of essential features.

Last year I discussed the basic rules to keep in mind when shopping for an EMR system. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com

Naturally, this is not only your best option over the long haul, but also the most expensive. However, all of us not planning to retire in the next decade will be looking into EMR whether we want to or not. So it behooves us to make sure efficient patient communication capabilities are an integral part of any system we choose.