July 2002 • Volume 8 • Number 7 |
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With all the splashy media coverage in recent months about "boutique medicine" -- pricey but personalized care that offers patients 24-hour access to their physicians -- it might come as a surprise to some that plenty of FPs already share their e-mail addresses with patients at no extra charge.
These physicians say the efficiency of e-mail communication holds real advantages for both patient and physician. And those who use it don't want to lose it, despite growing security concerns and federal regulations brought to bear by the Health Insurance Portability and Accountability Act.
Haven't tried e-mailing your patients yet? Note the high marks some AAFP members give this 21st-century mode of communication -- but heed their cautions as well.
"E-mail is a wonderful way to cut down on the extra visits of capitation
patients, and it is a perk for the fee-for-service patient," said Darlene
Lawrence, M.D., of Washington. "I offer all my patients two e-mail communications
a month at no charge." Additional
e-mails are charged at the same rate as an extended phone call, Lawrence said.
Lawrence built a disclosure statement into the automatic signature line of her office e-mail that addresses the confidentiality, time sensitivity and appropriateness of information that can be discussed electronically. "We tell patients that our e-mail has a 72-hour turnaround time -- and it's not for emergencies," said Lawrence. "My patients know up front that it is not Dr. Lawrence who is opening the e-mail, just as I am not the one to open 'snail mail' in my office."
Sometimes special circumstances make e-mail the best choice. Maj. Leslie Knight, M.D., of Lakenheath, England, has about 15 patients who e-mail her regularly. One patient's disability keeps her voice at a whisper. "I can barely hear the woman on the telephone," said Knight. But via e-mail, "we talk about symptoms, side effects of her medications and changes in dosing."
The key to e-mail communication is to stick to simple questions, said Knight. "We don't get into heavy 'Should I, or shouldn't I?' issues by e-mail, but a question like 'Where do I get a vasectomy?' can be answered in about 30 seconds, and it saves my nurse time on the phone."
Phone time is also an issue with Linda Siy, M.D., of Fort Worth, Texas. Siy practices at a community health center funded by the county, and she and some of her patients prefer e-mail because "it's easier than trying to snake through the county's automated phone system."
A recent example made believers of Siy's office staff. When new parents missed an appointment for a well-baby visit and immunization, the staff tried to contact them, as required by Medicaid. "They (the parents) were in India visiting family," said Siy. "We weren't able to reach them by phone, but they did read their e-mail."
Regardless of exceptional e-mail encounters, serious concerns exist about the security of protected health information and how HIPAA's privacy rule and security rule will affect the use of e-mail in the medical setting.
Jonathan Snider, M.D., of Hopkinton, Mass., understands the security issues and said he is awaiting the final word on HIPAA regulations that "may force me to use encrypted e-mail." For now, he said, "I tell my patients, 'If you're e-mailing from work, don't send me anything you wouldn't want to see in the company newsletter. If you're e-mailing from home, don't send anything you wouldn't want to see in the local newspaper.'"
David Kibbe, M.D., director of health information technology in the AAFP Socioeconomics Division, said physicians using nonsecure e-mail that contains personally identifiable patient information are taking a risk. "There is a risk that the e-mail contents will arrive somewhere and in front of some audience for whom they were not intended," he said."Physicians who engage in e-mail exchanges with patients should exercise caution and follow common-sense policies and procedures that limit the sensitivity of the information and its likelihood of disclosure."
Kibbe added it's going to take some time for medical organizations like the Academy to "provide protocols, policies and guidelines, and set standards we can all live with." (Go to http://www.aafp.org/policies.xml, and scroll down to "Confidentiality" to read the Academy's policy statements on confidentiality issues.)
It's important for the Academy to be proactive regarding this complicated and evolving issue, said Kibbe. "Our status gives us lots of opportunity to define what is reasonable and appropriate, and if we don't, those definitions will be provided by security folks rather than physicians."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.