PLEASE READ THIS PAGE BEFORE SENDING E-MAIL

Email, as it is generally used, is not secure.

Messages can be intercepted or incorrectly addressed. It may be impossible to verify the identity of the author of an email message. No matter what precautions are taken, any electronic transfer of information carries with it the risk of somebody intercepting that transmission and having access to the information it contains. 

The American Medical Association created a set of Electronic Communication Guidelines.  Here are just some (certainly not all) of their directives:
 
Communication Guidelines:

1. Establish turnaround time for messages. Exercise caution when using e-mail for urgent matters.
2. Inform patient about privacy issues.
3. Patients should know who besides addressee processes messages during addressee’s usual business hours and during addressee’s vacation or illness.
4. Whenever possible and appropriate, physicians should retain electronic and/or paper copies of e-mails communications with patients.
5. Establish types of transactions (prescription refill, appointment scheduling, etc.) and sensitivity of subject matter (HIV, mental health, etc.) permitted over e-mail.
6. Instruct patients to put the category of transaction in the subject line of the message for filtering: prescription, appointment, medical advice, billing question.
7. Request that patients put their name and patient identification number in the body of the message.
8. Configure automatic reply to acknowledge receipt of messages.
9. Send a new message to inform patient of completion of request.
10. Request that patients use autoreply feature to acknowledge reading clinicians message.
11. Develop archival and retrieval mechanisms.
12. Maintain a mailing list of patients, but do not send group mailings where recipients are visible to each other. Use blind copy feature in software.
13. Avoid anger, sarcasm, harsh criticism, and libelous references to third parties in messages.
14. Append a standard block of text to the end of e-mail messages to patients, which contains the physician’s full name, contact information, and reminders about security and the importance of alternative forms of communication for emergencies.
15. Explain to patients that their messages should be concise.
16. When e-mail messages become too lengthy or the correspondence is prolonged, notify patients to come in to discuss or call them.
17. Remind patients when they do not adhere to the guidelines.
18. For patients who repeatedly do not adhere to the guidelines, it is acceptable to terminate the e-mail relationship.

1. Develop a patient-clinician agreement for the informed consent for the use of e-mail. This should be discussed with and signed by the patient and documented in the medical record.
2. Provide patients with a copy of the agreement. Agreement should contain the following:
     •Terms in communication guidelines (stated above).
     •Provide instructions for when and how to convert to phone calls and office visits.
     •Describe security mechanisms in place.
     •Hold harmless the health care institution for information loss due to technical failures.
     •Waive encryption requirement, if any, at patient’s insistence.
3. Describe security mechanisms in place including:
     •Using a password-protected screen saver for all desktop workstations in the office, hospital, and at home.
     •Never forwarding patient-identifiable information to a third party without the patient’s express permission.
     •Never using patient’s e-mail address in a marketing scheme.
     •Not sharing professional e-mail accounts with family members.
     •Not using unencrypted wireless communications with patient-identifiable information.
     •Double-checking all "To" fields prior to sending messages.
4. Perform at least weekly backups of e-mail onto long-term storage. Define long-term as the term applicable to paper records.
5. Commit policy decisions to writing and electronic form.
6. E-mail correspondence should not be used to establish a patient-physician relationship. Rather, e-mail should supplement other, more personal, encounters.
7. When using e-mail communication, physicians hold the same ethical responsibilities to their patients as they do during other encounters. Whenever communicating medical information, physicians must present the information in a manner that meets professional standards. To this end, specialty societies should provide specific guidance as the appropriateness of offering specialty care or advice through e-mail communication.
8. Physicians should engage in e-mail communication with proper notification of e-mail’s inherent limitations. Such notice should include information regarding potential breaches of privacy and confidentiality, difficulties in validating the identity of the parties, and delays in responses. Patients should have the opportunity to accept these limitations prior to the communication of privileged information. Disclaimers alone cannot absolve physicians of the ethical responsibility to protect patients’ interests.
9. Proper notification of e-mail’s inherent limitations can be communicated during a prior patient encounter or in the initial e-mail communication with a patient. This is similar to checking with a patient about the privacy or security of a particular fax machine prior to faxing sensitive medical information. If a patient initiates e-mail communication, the physician’s initial response should include information regarding the limitations of e-mail and ask for the patient’s consent to continue the e-mail conversation. Medical advice or information specific to the patient’s condition should not be transmitted prior to obtaining the patient’s authorization.

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