Email in medical practice
Traditional communication methods have changed in all aspects of life and work. The effectiveness of modern, electronic communication may vary but the importance of excellent communication between patients and doctors and healthcare teams remains the foundation of a beneficial relationship that ensures good clinical outcomes and doctor and patient satisfaction.
The decision to use email to facilitate the transfer of patient information between caregivers or to provide an email service to patients is one best made with an understanding of the issues that may impact on the delivery of care and the day-to-day practice requirements.
The Royal Australian College of General Practitioners (RACGP) Standards for General Practice acknowledge that patients are able to obtain advice or information related to their clinical care by telephone or electronic means where the doctor determines that this is clinically safe and that a face-to-face consultation is unnecessary3.
Once the practice has made a decision to offer an email service there are a few things to consider in terms of general guidelines.
Practice considerations
Patients must make an informed choice to participate in an email service and to give permission for the electronic transfer of their medical information. Information about the rules of using the service, the risks and the process for opting-in and opting-out need to be provided to patients. There are a number of ways to do this but it is preferable that a brochure is provided to patients that they can take away and refer to when required. It may also be appropriate to post signs in the waiting room that the service is available along with reminders of the ‘rules’.
In terms of managing the actual process of receiving and responding to the emails:
- Allocate a senior staff member to be responsible for the overall management of email communications
- Depending on the type of practice, it may be appropriate to have a designated general email address
- All the usual computer security measures of access via secure passwords must be in place.
The GP Computing Group offers the following recommendations4:
- If you receive an email from a patient who has not signed a form, ask them to make an appointment to discuss the matter
- Check your messages daily – just as you would for phone messages or incoming test results
- Respond to emails within the agreed timeframe. Aim for the same time in which you would return a phone call. Two working days is reasonable
- Do not use email for bad news or sensitive matters
- Give simple, clear responses.
Boundaries of use
A decision should be made about the boundaries, or rules, of the email service. What type of consultation is appropriate and when must a face-to-face be booked? Can appointments be requested and confirmed via email? Are there any special circumstances in which the usual boundaries can be ‘stretched’ (e.g. patients who are travelling or are away from home)?
Consent
In light of the security issues with any email use, it is crucial that patients are informed of the risks with this form of communication and that they understand the strict guidelines for using the practice’s email service. Patients should acknowledge their understanding and provide consent by signing a form that becomes part of the medical record.
Security
The most commonly sought advice about email is the issue of encryption. Encryption of emails means your email data is scrambled and only through the use of the correct cryptographic key can it be un-encrypted. Encryption of email can only be successful when both parties have the appropriate programs on their computer. So, with this in mind, it is more likely that emails will be sent without encryption. Therefore other security measures must be put in place. Patients must be aware that the practice cannot guarantee confidentiality of information transferred via email.
Medical records
All sent and received emails must become part of the medical record.
Fees
The practice may decide that it is appropriate to charge a fee for email service. Special care should be taken to ensure patients are advised when a fee does not attract a government subsidy5.
It may take some planning, a robust policy and supporting procedures but email can be a useful tool in medical practice and supplement a good patient-doctor relationship.
By: Liz Fitzgerald
Clinical Risk Manager
3 RACGP Standards for General Practice. Criteriaon 1.1.2 Telephone and electronic advice at www.racgp.org.au
4 General Practice Computing Group at www.gpcg.org.au
5 RACGP Standards for General Practice. Criterion 1.2.4 Costs within our practice at www.racgp.org.au
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