Emailing Patients: Profitable? Yes -- Here's How

Batya Swift Yasgur, MA, LMSW

Disclosures

June 13, 2012

In This Article

Does Emailing Help or Hurt the Doctor-Patient Relationship?

"The physician-patient relationship is central to the practice of medicine. Key to this relationship is communication, which can be enhanced by email," says AAFP's Mitchell. "Email can be used for brief messages, updates, to clarify specific issues, correct misunderstandings before they become significant problems, and increase ongoing communication."

By contrast, Bierstock regards email as potentially damaging to the doctor-patient relationship. "In email, you can't gauge the reader's response. Even an apparently innocuous email, like asking a patient to come in to review labwork, can provoke anxiety. Patients worry that there might be something wrong."

Bierstock notes that because it takes only a moment to send an email, it's all too easy for a busy, overstressed physician to send an insensitively worded note. "Beyond routine administrative matters and the like, where emails are quite helpful, I think most interactions should be face to face."

He adds, "Medicine is an art and must take into account the patient's emotional needs, which usually can't be done as effectively and sensitively via email."

Although Kvedar strongly advocates emailing, he acknowledges that "there are times when I need to make eye contact with a patient, read the patient's mood, and look at dress, grooming, and demeanor. There are times when a handshake or thoughtful touch from a healthcare provider greatly enhances care -- but not all the time."

Peter Salob, MD, Chair of the Clinical Informatics Committee at Englewood Hospital and Medical Center, Englewood, New Jersey, and an orthopedist in a 10-physician private practice, agrees. "Nothing beats a good physical exam and history. Email augments, but doesn't replace, this in-person contact."

Protecting Patients' Privacy

"Privacy, confidentiality, security, and potential HIPAA violations are key concerns when it comes to emailing," states Mitchell. "But there are many solutions to this problem."

Contracting With Patients

"Some practices have created a consent form outlining security and privacy risks as well as other email-related issues," Mitchell says. "Patients are willing to accept those risks in exchange for the benefits offered by this type of communication. Although we emphasize the importance of a secure mechanism, ordinary email is an option, so long as everyone accepts the risks."

McGraw agrees. "I don't think it's the physician's responsibility to protect patients' privacy all the way down the food chain. Patients should be allowed the choice of prioritizing convenience, but it should be an informed choice."

But Nahra is skeptical about the value of consent forms and of disclaimers within emails. "If something goes wrong, patients usually don't care about forms or disclaimers," he says.

For this reason, many physicians are skittish about emailing. "I prefer to avoid email, even when patients ask for it. I seem to be more concerned about privacy than they are," states Wilfrid Noel Raby, MD, PhD, Assistant Professor of Psychiatry at Columbia College of Physicians and Surgeons in New York City and a psychiatrist in solo practice.

Also, warning patients of the limitations of email doesn't exonerate physicians of responsibility. McGraw clarifies: "If information from provider to patient is breached, the provider is on the hook to notify the patient and federal regulators of the breach." She emphasizes that breaches of security apply only to breaches for which the physician, as opposed to the patient -- is responsible. So, for example, if email is stored on a patient's laptop and there is a breach, it isn't the physician's responsibility.

Encryption: Yes or No?

Kvedar advises using encryption or a secure electronic portal to protect patient privacy. "Email is a critical part of moving patient care into increasingly virtual form. But I don't mean Gmail to Gmail. I'm talking about secure communication."

"My practice has just gone completely electronic," reports Salob. "Now, patients are given a username and password and communicate through the secure portal."

But portals have disadvantages. "Cost is a drawback," notes Mitchell. "Practices that don't wish to absorb this extra expense often assess an annual technology or subscription fee. Since it's not free, many patients don't want to use it."

Secure portals also tend to be less convenient. Many patients prefer their regular email account. For physicians as well, checking emails that arrive via the portal is an additional step that interrupts their customary workflow, says Bierstock.

How portals are set up also affects convenience. "In our system, an email has a maximum of 150 words. But there is no maximum on the number of emails that a given patient can send, so emails proliferate," reports McCarberg.

Investigating the different types of portals and matching them to the needs of your practice can help mitigate some of these difficulties.

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