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Communicating with patients by e-mail REST 5114: Introduction to Computing Instructors: Titus Schleyer, Heiko Spallek E-mail is ... … somewhere between letter-writing and talking. … more spontaneous than letter-writing. … less private than postal mail or telephone calls.

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Communicating with patients by e mail l.jpg

Communicating with patients by e-mail

REST 5114: Introduction to Computing

Instructors: Titus Schleyer, Heiko Spallek


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E-mail is ...

… somewhere between letter-writing and talking.

… more spontaneous than letter-writing.

… less private than postal mail or telephone calls.

… asynchronous.


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E-mail ...

… creates a written record.

… is useful for information a patient would have to remember.

… is self-documenting.

… is used by 113M Americans1.

… is used by 8M Americans for communication with health professionals2.

1www.pewinternet.org/reports/chart.asp?img=Internet_Activities.htm

2www.pewinternet.org/reports/toc.asp?Report=95


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The path of an e-mail message

Really?

computer

computer

dentist

patient


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5-min in-class exercise

  • Draw/write what you think is the real path of an e-mail message on the 5x7 card provided. (Please write/draw legibly.)

  • (Tip: There may be multiple possibilities.)

  • Then, hand your card to your neighbor.


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real

The path of an e-mail message


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When sending e-mail …

… double-check the “To:” line.

… assure that the recipient can easily communicate with you or your designee.

… use private (v. work) e-mail address for patient when possible.

… inform patients about privacy issues.

… use minimum necessary information (HIPAA).


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General policies

  • Respect patient preferences for communication.

  • Do not use e-mail for urgent matters.

  • Provide an alternate communication channel.

  • Include messages as part of medical record.

  • Request “message received” receipt.

  • Request “message read” receipt.


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General policies (cont.)

  • Establish type of transactions permitted over e-mail (e.g. appointment, prescription refill).

  • Instruct patients to put category of transaction (e.g. “billing question,” “medical advice” in subject line).

  • When sending group mailings, make sure recipients are not visible to each other.


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General policies (cont.)

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

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


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Mediocolegal guidelines

  • Obtain patient's informed consent for use of e-mail:

    • Itemize terms in Communication Guidelines.

    • Provide instructions for when and how to escalate to phone calls and office visits.

    • Indemnify the health care institution for information loss due technical failures.

    • Waive encryption requirement, if any, at patient's insistence.


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Mediocolegal guidelines (cont.)

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

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

  • Use encryption for all messages if available.


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Mediocolegal guidelines (cont.)

  • Auto-Reply text:

    "Your message has been received by Dr. Leslie Smith. I will attempt to process your request- within one business day. If you need immediate assistance, please call Pat, my assistant, at 444-555-6666.“

  • Use password-protected screen saver.

  • Perform at least weekly backups of e-mail.


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In-class exercise

  • Read the e-mail message on the following slide and identify three issues/problems.

  • Record the issues/problems on your 5x7 card.


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Further reading

  • Patt MR, Houston TK, Jenckes MW, Sands DZ, Ford DE. Doctors who are using e-mail with their patients: a qualitative exploration. J Med Internet Res. 2003 Apr-Jun;5(2):e9.

  • Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care? JAMA. 2003 Jul 9;290(2):259-64.

  • Ezenkwele UA, Sites FD, Shofer FS, Pritchett EN, Hollander JE. A randomized study of electronic mail versus telephone follow-up after emergency department visit. J Emerg Med. 2003 Feb;24(2):125-30.