Do you use email to communicate with your patients? Chances are good that you don’t. One recent survey of psychiatrists found that just 5% routinely and 25% sometimes used email with patients (Koh S et al, J Psychiatr Pract 2013;19(3):254-263). This means that there is a significant disconnect between what we do and what patients want, as over 70% of patients say they want to communicate with their providers electronically (Schickedanz A et al, J Gen Intern Med 2013;28(7):914-920).
In this article, I’ll start by describing my approach to emailing patients, and then discuss some of the legal and regulatory issues that you’ll need to consider as you develop your own policies.
I have been communicating with patients electronically in some format since beginning work at Purdue University in 2008, in large part in response to requests from the university students whom I treat. In the last several years, this has been via a secure messaging feature that is part of our electronic health record (EHR), which automatically encrypts communications. For many of my student patients, email or texting is their primary means of communicating with friends, family, and professors. It can be unusual for students to even talk on their mobile phones; it is not uncommon for many of them to not even have their voice mail set up.
Advantages of Email
Over the past few years, I’ve found several advantages of using email in clinical practice.
1. Convenience and workflow efficiency. Email cuts down on “phone tag” and overall time spent on the phone, since I can often address concerns more rapidly by email. Messages can be sent at the provider’s convenience and read at the patient’s convenience, making it a win-win for both parties. For example, I had one patient with depression whose screening lab work showed significant hypothyroidism. I was able to send the results to him directly via secure message, along with a referral list for endocrinologists. He wrote back within the hour stating that he had just made an appointment with an endocrinologist on the list, and was planning to print out his lab results to bring to that appointment.
2. Enhanced privacy. Yes, you read that right—ironically, given the common worry about privacy breaches with email, such communication often improves a patient’s ability to communicate with us privately. Patients who are at work or in other public settings are uncomfortable having a phone call about their mental health issues, but reading and responding to emails is discrete. I’ve also found that it can be a good way for patients to broach more sensitive topics, such as concerns about gender identity. Initiating a discussion over email provides a sense of safety and distance and can increase comfort about having a more thorough discussion at the patient’s next appointment. However, see the caveat below about protecting patient privacy in accordance with HIPAA regulations.
3. Enhanced communication of clinical information. When I provide medication instructions via email, I use a concise, clear format that patients can refer to several times if needed, increasing their understanding and adherence. I have found that electronic communication is ideal for sending lab results, medication handouts, referral lists to specialists, handouts detailing relaxation and sleep hygiene techniques, and for receiving and responding to prescription refill requests.
4. More efficient appointment management. I sometime use email for appointment reminders and to check in with patients after missed appointments. When I do this with university students, it is not uncommon to receive a reply within the hour explaining the circumstances of the missed appointment and stating an intent to reschedule. This is not only a source of relief when working with higher risk patients, but also substantially decreases the amount of time that would otherwise have been spent trying to follow-up with the student. If you are lucky enough to work with an EHR that provides a secure messaging feature for communicating with patients, this information will usually be automatically added to the patient’s medical record, further improving workflow efficiency.
Regulatory and Other Considerations
As you can see, there are many advantages of emailing patients— however, before you begin, you should know about various ethical, legal, and practical issues. (See “Five Tips for Using E-Communication Successfully in Your Practice” on p. 3 for a brief summary of recommendations).