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Communicating With Your Teen Patients by E-Mail: It’s Easy!

Communicating With Your Teen Patients by E-Mail: It’s Easy!. Hot Topics, Friday, March 24, 2006, Session II, 2:00- 2:15PM David Paperny MD FAAP FSAM I have no financial interest in any proprietary websites mentioned. E-mail Guidelines. AMIA Guidelines, 1998 8yrs ago!

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Communicating With Your Teen Patients by E-Mail: It’s Easy!

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  1. Communicating With Your Teen Patients by E-Mail: It’s Easy! Hot Topics, Friday, March 24, 2006, Session II, 2:00- 2:15PM David Paperny MD FAAP FSAM I have no financial interest in any proprietary websites mentioned

  2. E-mail Guidelines AMIA Guidelines, 1998 8yrs ago! www.amia.org American Medical Informatics Association releases, disclaimers, criteria, security 2 addresses, 1 list (bcc)

  3. Physician-Patient EmailSands, D; J Am Med Inform Assoc. 2004:260-67 Info updates: 41% Rx renewals: 24% Health questions: 13% Test results inquiry: 11% Referrals: 9% Other: 9% Appointments: 5% Non-health related: 5% Qualitative analysis of doctor-patient email 3007 messages over 11 months (83% one-issue) Sensitive info in only 5% Urgent messages 0%

  4. Anatomy of an E-mail Message • Address: user@hostCase-independent, no spaces • Subject line (Jimmy MR#445566 re: acne) • Messages: • Body(Text you type or copy, & MR# ) • Signature • Attachments (Describe all attachments)

  5. E-mail Signatures for Practitioners • The Most Important Part of Your E-mail! • Automatically append it to every outgoing message • Keep it short (5-7 lines) • Elements to consider: • Name, relevant degrees • Address, Phone & fax numbers • Best e-mail address used for PATIENTS ONLY • Disclaimers & standard info: • “In case of emergency…” • “This is not medical advice.” • “This is not my signature.”

  6. Body &Signature Hi Lisa: Your lab tests were ok. - - - - - - - - - - - - - - - :) - -- - - - - - - - - - - David Paperny MD,FSAM,FAAP  Kaiser Adolescent Clinic, Honolulu HI.Dr.DavidPaperny@kp.org Urgent matters, call (808)432-2400 This is not medical advice.   In emergency: 911 or 432-0000 No marketing activities or bulk mail.   This is not my signature. Never forward without permission. Intended for addressee only. Email placed in medial record: Include Medical Record number. Content not encrypted, protected, or guaranteed confidential.

  7. Consequences of No Signature • E-mail misinterpreted or ignored • “Huh? Who is this guy?” • Comments misinterpreted in undefined context • “This pe459x19@prodigy.com needs to ask a doctor!” • Recipients cannot respond to urgent info • “Does anyone know teendoc@ca.gov’s phone number?” • E-mail becomes dead end • “I tried to e-mail him back but it bounced. Oh well!” • Attachments avoided • “Whoa… is this a virus? I’d better delete it to be safe.”

  8. Writing E-mail with Patients • Like a phone message (informal, asynchronous) • Like a letter (hard copy, signature) • Netiquette often unfamiliar : R U goin 2 C me? • Acceptable uses: • Prescription refills • Documentation requests, Forms • General, non-urgent questions • Lab results (especially if confidential) • Routine follow-up / chronic disease management, ie. DM • Confidential / sensitive questions (ie. spotting on depo) • Appointment reminders (vs. calls, especially confidential)how feeq check?

  9. Office visit not needed Less intrusive Detailed Hard copy or into EMR Teens all have email Efficiency vs. tele calls Streamlines follow-up No reimbursement Overuse by some Nuances missing Admin support Netiquette Security issues Legal issues E-mailPros & Cons

  10. AMIA Guidelines: Communication • Establish turnaround time: often 2-4 days if not on vacation • Disclose privacy issues: who sees messages & when doc’s away • Establish acceptable uses and guidelines for sensitive matters • Content of “Subject” line to indicate type of message • Require patient ID : MR# in Subject or Body of message • Auto-reply & out of office responses: autoresponse via server: . “e-mail received, expect answer in a few days” “away from office until April 9. Call 432-0000 for assistance” • Print and put in chart, or copy into EMR • Request acknowledgment from patients–(don’t message cellphones) • Maintain a mailing list of patients-- use blind copying feature: bcc

  11. AMIA Guidelines: Administrative and Legal • Put your e-mail policies in writing (Informed consent?) • Agree to terms of your communication guidelines • Terms for “escalation” to telephone • Describe security protocols - & lack thereof, waive Encryption • Disclaimer for equipment failures • RULES: NO forwarding, marketing, sharing Dr’s e-mail address • ALSO: Password-protect workstations Use care with patient-identifiable data Double-check the “To:” field Back-up policy & procedure - Short-term, Long-term

  12. A Signed Written Agreement with Patients Kaiser-Permanente e-mail Agreement specifies: • Email non-urgent health questions or concerns which can wait a few business days for a response. • If your concerns are urgent, or you are ill, don’t use e-mail. • Issues best handled by e-mail include general questions about non-urgent or long standing problems, or test results. Kaiser-Permanente e-mail Consent form includes: • I understand that sensitive Protected Health Information may be contained in e-mail and I willingly choose to use this NON-SECURE method of communication. • I understand that my physician’s e-mail is not monitored in his/ her absence, and urgent /time-sensitive communications should be addressed by phone or office visit with a covering physician.

  13. Spam: Avoid Receiving It • Use filtering in your e-mail program • Whitelist patients in your address book • Have your e-mail server take care of it • Less control; more likely to miss real messages • Less fiddling with settings • Associated with pricey services, e.g., AOL • Route mail through spam-filtering service, e.g., SpamCop …OR use only Secure Messaging... not always feasible…

  14. Spam: Avoid Becoming It • Always use a “Subject” line • Make the subject very personal – eg: “John Doe -MR#556677 -lab results normal” • Use one e-mail account name for patient mail • Make sure you are whitelisted before sending important messages E-mail personality disorder (DSM-IV 301.73): • Rudeness: 90%, Flaming: 73%

  15. E-mail Reimbursement ? Spielberg AR.Online Without a Net: Physician-Patient Communications by Electronic Mail. Am J Law and Med. 1999;25:290-1 • “Public and private insurers do not see telemedicine as a therapeutic modality that deserves reimbursement, …so • E-mail consultations will likely not be reimbursed. • This is consistent with traditional medical practice where telephone calls and letters are not reimbursed.”

  16. A Simple Approachto E-mail with Patients • You email patientthe terms of email service: including Policies and Rules, • Patient Replies with a copy of your terms and includes MR#, Birthdate, & “I Agree”

  17. SummaryE-mail with Patients • E-mail skills • Signature • Use e-mail lists: Two addresses*, one list *1 to communicate, 1 to send • Spam: filters, server-side • E-mail Process • Look to AMIA e-mail guidelines for policies • Consider “Secure Messaging”

  18. E-mail - like Telephone Calls • not encrypted or authenticated • may breach privacy by using employer e-mail • no charge capture function • no template or medical records features • not “safety-proofed” for healthcare • not always consistent with HIPAA or eRisk standards

  19. Mailing Lists - use bcc !! “Two Addresses, One List” LISTSERVs=bang for the buck: cheap conferencing • SubscribeLISTSERV by e-mail • Send request to ADMINISTRATIVE address (e.g.,LISTSERV@teendoc.com) • ParticipateLISTSERV by e-mail • Send message to MAILING LIST address (e.g., LISTNAME@teendoc.com) • UnsubscribeLISTSERV by e-mail • Send request to ADMINISTRATIVE address(e.g., LISTSERV@teendoc.com) • Keep LISTSERV instructions ( like SAM-L )

  20. Web-based Mailing ListsNot via E-mail • Offers a listserv that all your patients can JOIN – they interact and share “discussion” you authorize • PEDTALK Mailing List = http://www.pcc.com/lists/

  21. E-mail & Messaging vs. Phone • NEJM 350:1705-1707, 2004. Delbanco T, Sands D,Electrons in Flight - E-Mail between Doctors and Patients. • PEDIATRICS Vol. 114 No. 1, July 2004, pp. 317-321 E-mail Communication Between Pediatricians and Their Patients;Gerstle R, and AAP Task Force on Medical Informatics http://pediatrics.aappublications.org/cgi/content/full/114/1/317 Reports e-mail patient communication issues for physicians & appropriate use of e-mail in the office setting: • e-mail in the office environment • available e-mail technologic solutions • e-mail privacy and security concerns • legal status of e-mail

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