Look before you leap into practicing via e-mail
Look before you leap into practicing via e-mail
Monitor your telephone communication policies
While studies show that patients are eager to communicate with their doctors on the Internet, many physicians are reluctant to take the plunge into patient e-mail and web pages for fear they’ll be opening up themselves to a host of problems.
The Internet can be an efficient and effective tool for communicating with patients, but physicians should take some precautions, advises Bob Waters, a health law attorney with Arent Fox Kintner Plotkin & Kahn in Washington, DC.
"The fundamental issue that any physician or health care provider has to face in dealing with a patient in person or on-line is whether they have the information necessary to render a diagnosis or prescribe an appropriate treatment," Waters says.
As Internet technology progresses, physicians are likely to be able to practice interactive medicine over the Internet by video streaming or videoconferencing that makes the experience more like face-to-face contact in the office, Waters says.
But even now, patient-physician e-mail can be a time-saver for both parties in many instances as an alternative to phone tag. "The current way of leaving a message and having the doctor call you back is very inefficient. E-mail could be a very efficient way to deal with questions and problems," he adds.
Physicians who use the Internet to communicate with patients must have the same kind of safeguards in place that they would use if the patient called into a doctor’s office — plus a few others, warns Karla Kelly, an attorney with San Diego-based Luce, Forward, Hamilton & Scripps.
"The [key to] Internet communication is that the professional remains cognizant at all times that he needs to exercise the same kind of judgment and discretion as in any other kind of communication," Kelly says.
Before establishing a web site or e-mail communication system, see a health law attorney and work out some of the issues that might come up so your exposure will be minimized, Kelly suggests.
Check with your insurance carrier to make sure you will be covered under your malpractice policy for Internet communication. Make sure if you are communicating with patients over the Internet that you are also complying with the policies of any institution, such as clinic or hospital, with which you are affiliated.
The same issues come up for other professionals who talk to clients over the Internet. The issues are different if you are talking about established patients whom the physician has seen and treated or people who are simply part of a response to a web site.
Confidentiality issues
"One reason physicians are reluctant to communicate on the Internet is the physician-patient confidentiality issue," Kelly says. For instance, once you or the patient is on the Internet, anybody coming into the room at either end can see the screen. This could violate confidentiality laws, particularly since in most states the relationship between patient and physician is even protected from family members, Kelly says.
Put some mechanisms into place to ensure that the person sending the e-mail is the patient and that the information coming across the line is protected, she advises.
There is no method of accurately determining that you are, indeed, communicating with your patient unless you employ a system of codes, which would be cumbersome, Kelly says. Instead she advises physicians to get their patients to sign a release form before they communicate by e-mail. The release form should release physicians from an inadvertent breach of confidentiality, if it occurs on the patient side of the communication.
The form should make patients responsible for monitoring the information on the computer screen and for making sure that they are the only ones in their household who communicate with the physician about their medical condition.
The biggest difference in answering a patient inquiry by e-mail and answering it by telephone is the patient’s expectation that e-mail will be answered more quickly, Waters says. That’s why you should carefully define the nature of the e-mail service your are providing and set criteria for how often it will be answered, he says.
Tell patients upfront how quickly they can expect an answer so that patients in a life-threatening situation aren’t sitting around waiting for an e-mail to be answered, he advises.
Obligation to respond
Physicians have the same obligation to respond to e-mails as they have to respond to telephone calls, Kelly points out. "Doctors should have someone monitoring their e-mail just as they have someone monitoring the telephone."
If you come up with an arrangement to contact patients by e-mail, make sure you set standards for retrieving the messages similar to your standards for answering the telephone. Keep in mind that communicating by the Internet does not release you from the ongoing obligations to treat patients as you would normally, Kelly points out.
If it’s an existing patient, recognize that you may be operating on less information than you would if you see the patient in person, Waters adds.
"The Internet cannot take the place of appropriate face-to-face meetings. Physicians still must make sure they physically see the patients when they need to do so," Kelly says.
Set up the same type of triage-type mechanism you have for telephone calls so that your staff can determine which patients e-mailing a question or concern need to come in for an appointment.
If you customarily charge your patients for telephone consultation, you should be able to charge for an e-mail consultation, Kelly says.
When you do correspond with a patient by e-mail, make sure you print out a copy of the correspondence and insert it in the patient file. "Proper documentation is essential for any kind of communication," she says.
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