Physician-Patient Electronic Communication Curriculum Manual

•In most states, electronic communication is appropriate only after an in-person physician-patient relationship has been established •Electronic communication with patients must be docum

Physician-Patient Electronic Communication

Curriculum Manual

Katrina Miller, MD1Heather Paladine, MD2Brett White, MD3Chris Feifer, DrPH4

Corresponding Author: Heather Paladine, MD

Assistant Clinical Professor of Medicine New York Presbyterian/Columbia University Medical Center Center for Family and Community Medicine

610 West 158th St New York, NY 10032 212-544-1864 hlp11@columbia.edu

March 2010

1 Assistant Professor, Clinical Faculty, Glendale Adventist Family Practice Residency Program, Glendale, California

2 Assistant Clinical Professor of Medicine, New York Presbyterian/Columbia University Medical Center, Center for Family and Community Medicine

3 Assistant Professor, Oregon Health and Sciences University

Table of Contents

Part One: Background, Terminology, Security and Guidelines, Informed Consent and Documentation

Handouts

Part Two: Appropriate Communications, Problem Situations and Sample Scenarios

Guide for Presenters

Welcome to our curriculum As you know, electronic communication is a very important aspect

of life in the 21st century Patients are very interested in online information and electronic communication with their health care provider There are potentially serious medico-legal ramifications of email use in the physician/patient relationship that must be addressed Due to a need we saw in our Family Medicine Residency program, and in accordance with the tenets of the Future of Family Medicine Project our group has developed this curriculum in order to help residents and attending physicians understand and feel more comfortable with electronic

communication with their patients This curriculum is part of a research study started in 2007 to evaluate and improve the knowledge, skills and deficiencies regarding physician-patient

electronic communication The study and curriculum were made possible by an STFM

Foundation Grant through the Group on Information Technology

1) Curriculum Materials

 The curriculum includes two PowerPoint presentations, which are designed to be taught during a one-hour resident didactic sessions

 Notes for faculty presenters are included in this manual (in italics under the slide text),

and are available as well as in the notes section of many PowerPoint slides This manual

or “Notes” pages can be printed from the PowerPoint files for use as a guide during the presentation

 Note that some slides are set to reveal the slide text on a second click of your mouse or keyboard This “progressive reveal” allows the group to discuss the question on the slide before our answers are revealed

 The PowerPoint slides are represented in this manual with a number header that refers to the presentation number (1 or 2) and the slide number (1-30) So slide “1-10” is in the first presentation, slide number 10

 Handouts accompany each presentation You may choose to share these electronically or

on paper Make sure to print or otherwise provide the “Sample Emails” in the second

presentation for discussion

2) Educational Objectives

 The presentations begin with educational objectives for that section

 Specific ACGME competencies are indicated in the notes

3) Terms

 Although we use the terms “email” or “electronic communication” throughout the

curriculum, the content addresses various forms of electronic communication, including secure web portals, but deferring discussion of short form electronic communication such

as texting or “Twitter”

 Additionally, although we use the term physician-patient electronic communication, we realize that your residency program may have other types of providers

4

SLIDES AND SPEAKER NOTES- PART ONE

The curriculum is divided into two parts The suggested time commitment is one hour for each part This is the first PowerPoint presentation Make sure to print handouts that you may want to use before the presentation (See pages 12-24)

1-1

Physician-Patient Electronic Communication Curriculum:

Assistant Clinical Professor of Medicine

New York Presbyterian/Columbia University Medical Center

Center for Family and Community Medicine

•Part 2: Appropriate Communications, Problem Situations and Sample Scenarios

Notes: The curriculum is divided into 2 parts The suggested time commitment is one hour for each part.

Background, Terminology, Rules and Regulations, Documentation and Informed Consent

Objectives: At the completion of this section, the learner will be able to:

•Define specific terms and guidelines related to physician-patient electronic

communication

•Discuss security issues with regard to electronic communication

•Identify guidelines for electronic communication

•Complete an informed consent with a patient

Notes: ACGME competencies: Practice based learning and improvement, Systems based

practice

1-5

Part 2: Appropriate Communications, Problem Situations and Practice Scenarios

Objectives: At the completion of this section, the learner will be able to:

•Understand appropriate electronic communication

•Understand inappropriate patients with whom to communicate electronically

•Understand inappropriate topics for electronic communication

•Recognize how and when to end electronic communication and change to another form

of communication

•Critique electronic communication with patients based on presented guidelines

Notes: ACGME competencies: Patient care, Professionalism, Interpersonal and Communication skills, Practice based learning and improvement

1-6

First, Some Definitions:

•What do we mean by electronic communication?

•Electronic Communication

–Asynchronous online communication with patients -email or secure web portal

•We are not including short phrased, real-time texting, chatting or Twitter, etc.*

Notes: *These types of communication with patients may be more used in the future and will necessitate similar focus, but are not addressed in this presentation

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First, some definitions (cont):

•Web-based Email

–Email accessible from any internet capable device

•Portal or Secure Website Messaging

–Online website that provides services, such as email, links to other sites and media –Usually has a separate username and password

–Generally has more security features than web-based email

•Physician-patient communication may use either system

Notes: The Terms and Definitions handout goes along with this section Depending on your audience’s familiarity with these terms, you may choose to review the handout now or distribute

as a reference

1-8

Discuss: Why use electronic communication with patients? What do you think?

•Email communication is ubiquitous -70% of people in the U.S have access to email

•Among low income Americans, more than 1/3 have email access

•Electronic communication can be a time saver and avoid phone tag

•Electronic communication is easy to document and archive

•Electronic communication can be reimbursed

•Many patients want to email their doctors

Notes: Text in italics on the slide refers to discussion points

The bullet points on the slide will appear the second time you advance the slide Have the group brainstorm some of their own answers before you give them ours.

http://www.internetworldstats.com/stats2.htm

Hsu et al Use of e-Health Services between 1999 and 2002: A Growing Digital Divide.

J Am Med Inform Assoc 2005; 12: 164-171

Why Learn About Electronic Communication with Patients?

•Electronic communication is becoming more common -you are likely to get requests from patients

•1/3 of patients would be willing to pay extra for email access

–About half say that email access would influence their choice of doctors or health plans

•The majority of patients who email would like to email their physicians (90%)

–However, only 10-15% of patients have used email with their doctors

•It’s important to know potential benefits and pitfalls so that you can decide if you want

to add this to your future practice

Notes: The bullet points on the slide will appear the second time you advance the slide Have the group brainstorm some of their own answers before you give them ours.

http://www.harrisinteractive.com/news/newsletters/healthnews/

HI_HealthCareNews2002Vol2_Iss08.pdf

In Boston, up to 75% of primary care physicians have used email with 5% of their patients Leong et al Enhancing Doctor-Patient Communication Using Email: A Pilot Study The

Journal of the American Board of Family Practice, 2005; 18:180-188

Patients are very interested in online information and email communication with their

practitioners BMJ 2004;328:1148-1149 (15 May)

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Integrated Electronic Health Record (EHR)

•Web-enabled electronic health documentation that has electronic communication as part of the system

•Electronic medical information is accessible for communication, e.g., labs results, chart notes

•Messages are automatically saved as part of the Electronic Health Record

1-11

What does HIPAA say about electronic communication with patients?

•The Health Insurance Portability and Accountability Act

•HIPAA requires: “appropriate administrative, technical and physical safeguards to protect the privacy of patient information”

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What does HIPAA say about electronic communication with patients?(cont)

•Regulations don't name a particular technology

•Wide range of options:

–Portal technology

–Password protection

–Various types of encryption*

Notes: *see “Terms and Definitions”

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Is Encryption Mandatory?

•Under HIPAA email encryption is not mandatory

•However, encryption is an appropriate and cost-effective method of email security

What do you think?

•Do you think email is secure for confidential transmission of health information?

Notes: Progressive reveal

There is no correct answer to this question!

This is why informed consent, discussed later in the presentations, is so important

1-14

Risks of Using Electronic Communication -What do you think?

•Emails may not be secure and therefore it is possible that the confidentiality of such communications may be breached by a third party

•Electronic communication can be intercepted, circulated, forwarded, and broadcast to

or used by unintended recipients

•Electronic communication may be stored electronically and on paper and found or used

by inappropriate parties

•Senders can easily misaddress a message

Notes: The bullet points on the slide will appear the second time you advance the slide Have the group brainstorm some of their own answers before you give them ours.

1-15

Risk of Using Electronic Communication

•Email can contain computer viruses

•Employers and on-line services have a right to inspect email transmitted through their systems

•Electronic communication can be used as evidence in court

Electronic Communication Guidelines

•The most commonly cited are provided by the American Medical Informatics

Association (AMIA)

AMIA White Paper

Beverly Kane, MD, and Daniel Z Sands, MD, MPH, for the AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail

JAMIA 1998; 5: 104-111

Notes: These are the most commonly cited guidelines on physician-patient email The full text of this article may be accessed at: http://www.amia.org/mbrcenter/pubs/email_guidelines.asp

1-17

AMIA Communication Guidelines

•Establish turnaround time for messages Do not use email for urgent matters

•Establish types of transactions (prescription refill, appointment scheduling, etc.) and

subject matter (generic questions, lab results) permitted over email

•Inform patients about privacy issues Patients should know: Who besides addressee processes messages

–During addressee's usual business hours

–During addressee's vacation or illness

Notes: These guidelines are divided into communication guidelines and

medico-legal/administrative guidelines

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AMIA Communication Guidelines (cont)

•Instruct patients to put category of transaction in the subject line of message for

filtering: "prescription," "appointment," "medical advice," "billing question."

•Avoid sensitive terms in subject line, for example: “HIV question”

•Request that patients put their name and date of birth or patient identification number in

the body of the message, not the subject line

1-19

AMIA Communication Guidelines (cont)

•Configure automatic reply to acknowledge receipt of messages Request that patients

use autoreply feature to acknowledge receiving provider's message

•Send a new message to inform patient of completion of request (such as a prescription refill)

•Avoid anger, sarcasm, and criticism in messages

•Document all messages: either electronic charting or print copy of email in the

patient’s paper chart

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AMIA Medico-legal and Administrative Guidelines

•An office policy on electronic communication is recommended.

•Consider obtaining patient's informed consent for use of electronic communication

(discussed more later)

•Use password-protected screen savers for all computer workstations

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

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AMIA Medico-legal and Administrative Guidelines (cont)

•If encryption is available and practical, it should be used for all messages

•Do not use unencrypted wireless communications with patient-identifiable information

•Double-check all "To:" fields prior to sending messages It’s easy to send email to the wrong recipient!

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Question

Which of the following is not recommended with regard to physician-patient electronic communication?

A.Obtain informed consent from patient and keep a copy on record

B.Assume that a patient has received your email.

C.Avoid patient identification information in the “Subject line”

D.Establish turnaround time for messages

Notes: The answer is B!

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Questions

•Describe one guideline from the AMIA White Paper.

•Name two ways that you could make electronic communication with your patients safer

•In most states, electronic communication is appropriate only after an in-person

physician-patient relationship has been established

•Electronic communication with patients must be documented (just like other forms of communication)

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Informed Consent

•Electronic communication has benefits and risks that should be discussed with the patient

•Consider having patients sign a consent form before starting electronic communication

•Secure web portals may use an online consent process

•Maintain a copy of the consent in the patient’s medical record

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Electronic Communication-Policy and Procedure

•All staff who choose to communicate with a patient electronically could have a

disclaimer attached as a footnote to all NEW messages A suggested wording is:

“This message is confidential, intended only for the recipient(s) named above and may contain information that is privileged If you are not the intended recipient, do not

disclose or disseminate this message to anyone except the intended recipient If you have received this message in error, or are not the named recipient(s), please

immediately notify the sender by return email, and delete all copies of this message.” Notes: A sample consent form is provided as a handout

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Electronic Communication-Policy and Procedure (cont)

•In addition, response to a patient's electronic communication from staff should contain the full name of the staff member, the health center’s telephone number and fax

number, and the following suggested statement:

"Although (practice name) makes reasonable efforts to protect the confidentiality of email from patients, communications regarding highly confidential medical matters should be reserved for other forms of communication, such as telephone or personal visits In addition, you should not use email for emergencies or other time-sensitive matters All email communications between you and (practice name) are governed by the terms of the (practice name) Patient Email Consent Form Should you have any questions or concerns about our policies regarding email communications or the

content of the Email Consent Form, please contact: _.

1-28

Electronic Communication Documentation

•Physician-patient electronic communication is like any other part of the medical record

•Physicians should retain copies of messages in the patient’s medical record (either paper or electronic)

•If the patient hasn’t signed a consent form, consider not continuing with electronic communication

1-29

Reimbursement

•Currently, the majority of physician-patient electronic communication is not reimbursed

•Most physicians who charge for electronic communication do so as a subscription service, separate from health insurance

–For example, a doctor may charge a patient $15/month for email access

–Some physicians charge a fee for each “online visit” -typically a more detailed

communication

Reimbursement

•Some insurance companies (such as Aetna and Cigna) are beginning to pay for electronic communication, but this is not common

•CPT code 99444 covers electronic communications with patients:

“Online evaluation and management service provided by a physician to an established patient, guardian or healthcare provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic

Electronic Communication in the Residency Practice

•Electronic communications should be precepted, just like visits and phone calls

•This should be addressed by the office policy

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Questions?

Can you now:

•Define specific terms and guidelines related tophysician-patient electronic

communication?

•Discuss security issues with regard to electronic communication?

•Identify guidelines for electronic communication?

•Complete an informed consent with a patient?

1-33

Overview of Curriculum

•End of Part 1: Background, Terminology, Security and Guidelines, Informed

Consent and Documentation

NEXT:

•Part 2: Appropriate Communications, Problem Situations and Sample Scenarios

Notes: The curriculum is divided into 2 parts The suggested time commitment is one hour for each part.

14

END

Physician-Patient Electronic Communication Curriculum:

PART ONE

Terms and Definitions

Electronic Health Record

The full functionality of systems which use electronic medical information

Electronic Medical Record (EMR)

 The EMR is the legal record or data created in hospitals and ambulatory environments that is the source of data for the EHR

 Often used synonymously with Electronic Health Record (EHR) – but they are different

 Computer based system which manages health information

 Part of Health Information Technology (HIT)

Encryption

Conversion of a text file into a decipherable code for transmission so only the holder or system with the code may decipher back to the original text

HIPAA

Health Insurance Portability and Accountability Act, enacted in 1996, and has multiple

components, including privacy of patient information (See PHI)

HTML

 Hypertext Markup Language with the extension: html or htm

 A system by which written text may be enhanced with embedded links to other web media, creating a more interactive document than text alone

 Patients with slow internet connections may not be able to access HTML

Integrated EHR

Web-enabled electronic health record that has email communication as part of the system

 Electronic medical information is accessible for communication, e.g., labs results, chart notes

 Emails are automatically saved as part of the electronic health record

Text

 Message in written form only

 File extension may be txt

 Easily accessible for any user with any system

Password Protection

Access granted only with correct username and password

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Patient-provider electronic mail

 Defined by the American Medical Informatics Association (AMIA)

 Computer-based communication between clinicians and patients within a contractual relationship in which the health care provider has taken on an explicit measure of

responsibility for the client's care

Personal email

 Email communication service established by an individual

 Available for any personal use, no limitations as to messages or material sent except for size

 Security: password protected, perhaps encrypted

Portal or Secure Website Messaging

 Online website that provides services, such as email, links to other sites and media are available

 Access to system and unique account may be username and password protected for added layers of security

 This system may alert the patient through email that they have a secure message, but they will have to log in to a separate website to read the message

Protected Health Information (PHI)

PHI is defined by HIPAA consisting of any information which identifies or could be used to identify an individual and has anything to do with past, present or future physical or mental health conditions, care or payment for care and includes the following:

 Name

 Address

 E-mail address

 Birth date (except year)

 Social Security number

 Employee number

 Claim number

 Health plan beneficiary number

Web based email

 Email accessible from any internet capable device

Work email

 Email communication provided by workplace

 Material sent limited by workplace rules, generally the property of the workplace Remember, if patients use their work email, their employer will have access

 Security: password protected, perhaps encrypted, perhaps a secondary login to the workplace portal As a physician, your work email may have a higher level of security than a personal email account

AMIA Guidelines

AMIA guidelines can be accessed at:

http://www.amia.org/mbrcenter/pubs/email_guidelines.asp

Sample Office Policy – 1

Policy for Controlling Email Content

Institution 5 Policy: Email Communication with Patients

POLICY

Health information specific to an identifiable patient must be protected as confidential

information Because the Institution cannot ensure that the intended person(s) will receive new

emails, faculty and staff must include a disclaimer at the end of initial emails Since it is

impossible to ensure that information received or sent by email will be kept private, and to reduce your risk of being held liable for damages for email–related privacy violations, special procedures must be followed to ensure informed consent by the patient if the patient and faculty

or staff chooses to communicate by email Additional procedures may be required to meet HIPAA standards

PROCEDURE

A All faculty and staff who choose to communicate with a patient by e-mail should have a disclaimer attached as a footnote to all new email messages For email replies, it is not required but is recommended The suggested wording is:

“This e-mail message is confidential, intended for the recipients(s) named above and may contain information that is privileged, exempt form disclosure under applicable law If you are not the intended recipient, do not disclose or disseminate this message to anyone except the intended recipient If you have received this message in error, or are not the named recipient(s), please immediately notify the sender by return email, and delete all copies of this message.”

B All faculty and staff, who choose to communicate with a patient by e-mail, are strongly encouraged to have the patient sign a Patient Email Consent Form In the attached Patient Email Consent Form, the patient acknowledges that he or she understands the risks of

emailing information, consents to use email anyway, and agrees to follow our instructions regarding email

Before initiating or responding to a patient email, you are encouraged to follow this procedure:

1 Hand the Email Informed Consent form to the patient while in your office or facility, or fax/email the form to the patient to sign An electronic version is available at the

4 Terminate email privileges if a patient fails to comply with the guidelines on the consent form.

5 If the patient refuses to sign the consent form, do not communicate with that patient by mail You may elect to reply to the sender the following message:

e-For the protection of your own privacy, I have a policy of not communicating with patient via email about potentially confidential health or financial matters until I have received a signed Patient E-mail Consent Form I have attached a form of this Consent that we would ask you to review and sign and return to us by U.S mail at the address listed on the form By signing the Agreement, in the future, I will accept certain

communications from you via email about certain matters.

We regret any inconvenience this may cause you.

C The subject line in email correspondence should not contain personal information

D Do not include any Social Security number in emails

E If an Institution health-oriented website displays an email address for potential or existing

patients to use on order to contact that department, an alert should warm the patient that this

is not a secure network

F Information that is provided by email or on a medical practice web site should come either directly from the health care provider or from a recognized and credible source after review

by the provider

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Sample Office Policy-2

Institution DEPARTMENT OF FAMILY MEDICINE

OPERATING POLICIES

POLICY STATEMENT:

Health information specific to an identifiable patient must be protected as confidential information.

Because Institution Family Medicine cannot ensure that the intended person(s) will receive emails,

faculty and staff must include a disclaimer at the end of initial emails Since it is impossible to ensure

that information received or sent by email will be kept private, and to reduce Institution Family

Medicine’s risk of being held liable for damages for email-related privacy violations, special procedures must be followed to ensure informed consent by the patient if the patient and faculty or staff chooses to communicate by email

In addition, as a result of limitations in technology used by a majority of Institution Family Medicine’s patients, Institution Family Medicine not accept e-mail communications in lieu of an ink

signature in connection with any form, consent or authorization that requires a signature Similarly,

Institution Family Medicine will not accept digital signatures evidencing a patient's authorization Institution Family Medicine anticipates modifying this policy at a future date following the issuance

of final Federal Electronic Signature Standards (and applicable state requirements).

PURPOSE:

To protect the confidentiality of health information when it is contained in an email sent from

Institution Family Medicine to patients.

PROCEDURE:

I. All staff who choose to communicate with a patient by email regarding protected health

information are required to have the patient sign a Institution Family Medicine Patient Email

Consent Form (attached) in which the patient acknowledges that he or she understands the risks of emailing information, consents to use email anyway, and agrees to follow our instructions regarding email.

Before initiating or responding to a patient email, you should follow this procedure:

1 Hand the Institution Family Medicine Patient Email Consent Form (see attached) to

the patient while in your office or facility, or fax/email the form to the patient to sign

2 A patient can sign the form while in your office or facility or return the form by mail

or fax The form should be filed in the patient’s medical record

3 Retain copies of email correspondence in the patient’s medical record for each correspondence.

“For the protection of your own privacy, I have a policy of not communicating with patients via email about protected health or financial matters until I have received a signed Institution Family Medicine Patient Email Consent Form I have attached a Consent Form for your review and signature which you may return as indicated on the consent form By signing the Consent Form, in the future, I will accept certain communications from you via email about certain matters I regret any inconvenience this may cause you.”

II All staff who choose to communicate with a patient by email should have a disclaimer attached as

a footnote to all new email messages The disclaimer is required The approved wording is:

“This email message is confidential, intended only for the recipient(s) named above and may contain information that is privileged If you are not the intended recipient,

do not disclose or disseminate this message to anyone except the intended recipient If you have received this message in error, or are not the named recipient(s), please immediately notify the sender by return email, and delete all copies of this message.”

In addition, every response to a patient's e-mail communication from staff will contain the full name of the staff member; the health center’s telephone number and fax number; and the following statements:

"Although Institution Family Medicine makes reasonable efforts to protect the confidentiality

of email from patients, communications regarding highly confidential medical matters should

be reserved for other forms of communication, such as telephone or personal visits In addition, you should not use email for emergencies or other time-sensitive matters All email communications between you and Institution Family Medicine are governed by the terms of the Institution Family Medicine Patient Email Consent Form Should you have any questions

or concerns about our policies regarding email communications or the content of the Email Consent Form, please contact our staff at 323-442-5900.

III All staff members who receive an email communication from the patient that conforms to the requirements of the patient's signed Email Consent Form will:

(i) act reasonably and responsibly to obtain and prepare an appropriate response to the patient's

communication;

(i) to the extent necessary, deliver the email communication to the appropriate person within

Institution Family Medicine; and

(ii) indicate to the patient the process and timing for when Institution Family Medicine will

provide a more complete response

IV The subject line in emails should not contain personal information (e.g name, ID number).

V Do not include any Social Security number in emails.

VI. If the Institution Family Medicine health-oriented website displays an email address for

potential or existing patients to use in order to contact that department, an alert should warn the patient that this is not a secure network.

VII Medical advice that is provided by email should come directly from a licensed health care

professional or their designee who is familiar with the patient’s medical condition and the

patient must have been previously examined by a health care provider within Institution Family

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VIII. If Institution Family Medicine staff determines that responding to a patient's specific email is

inappropriate or impractical, the Institution Family Medicine staff member may request that the

patient either speak with the staff member by phone or make an appointment for an in-office visit This decision should be documented in the patient’s record.

IX Refer to Medical Director to evaluate termination of email privileges if a patient fails to comply

with the guidelines on the Institution Family Medicine Patient Email Consent Form

X. Vacations: If a staff is off for vacation or other extended leave over three working

days, the clinician should place vacation email response on their email

XI Lab: It is against California law to send the following results via electronic means:

(1) HIV antibody test.

(2) Presence of antigens indicating a hepatitis infection.

(3) Abusing the use of drugs.

(4) Test results related to routinely processed tissues, including skin biopsies, Pap smear tests, products of conception, and bone marrow aspirations for morphological evaluation, if they reveal a malignancy.

Sample Patient Handout

Using email to communicate with Institution Family Medicine Staff

Do’s and Don’ts

Do

1) Do fill out AND READ the informed consent for communication with the health

center Without this we cannot communicate with you on medical information

2) Do place your name and contact phone number in each e-mail you send your clinician.3) Keep your email as short as possible

Don’t

1) Do not use this communication for urgent or emergency issues

2) Do not use this form of communication for highly confidential issues

3) Do not put your social security number in the email

4) Do not put confidential information or specific information in the topic (use instead

e.g medical question, lab result)

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Sample Consent Form – Format #1

Institution PATIENT EMAIL CONSENT FORM

To address the risks of using email

Patient Name:

Patient Address: _

Email:

Provider: _

1 RISK OF USING EMAIL

Transmitting patient information by email has a number

of risks that patients should consider before using email.

These include, but are not limited to, the following

risks:

a) Email can be circulated, forwarded, stored

electronically and on paper, and broadcast to

unintended recipients.

b) Email senders can readily misaddress an email.

c) Backup copies of email may exist even after the

sender or the recipient has deleted his or her copy.

d) Employers and on-line services have a right to

inspect email transmitted through their systems.

e) Email can be intercepted, altered, forwarded, or

used without authorization or detection.

f) Email can be used to introduce viruses into

computer systems.

g) Email can be used as evidence in court.

h) Emails may not be secure, including at Institution,

and therefore it is possible that the confidentiality

of such communications may be breeched by a

third party.

2 CONDITIONS FOR THE USE OF EMAIL

Providers cannot guarantee but will use reasonable

means to maintain security and confidentiality of email

information sent and received Providers are not liable

for improper disclosure of confidential information that

is not caused by Provider’s intentional misconduct

Patients must acknowledge and consent to the following

conditions:

a) Email is not appropriate for urgent or emergency

situations Provider cannot guarantee that any

particular email will be read and responsive to

within any particular period of time.

b) Email must be concise The patient should

schedule and appointment if the issue is too

complex or sensitive to discuss via email.

c) All email will usually be printed and filed in the

patient medical record.

d) Office staff may receive and read your messages.

e) Provider will not forward patient identifiable emails

outside the Institution without the patient’s prior

written consent, except as authorized or required by law.

f) The patient should not use email for communications regarding sensitive medical information

g) Provider is not liable for breached of confidentially caused by the patient or any third party.

h) It is the patients responsibility to follow up and/or schedule an appointment if warranted

INSTRUCTIONS

To communicate by email the patient shall:

a) Avoid the use of his/her employer’s computer b) Put the patients name in the body of the email c) Key in the topic (e.g medical questions, billing question) in the subject line.

d) Inform provided of changes in his/her email address.

e) Acknowledge any email received from the Provider.

f) Take precautions to preserve the confidentially

as well as any other instructions that the Provider may impose to communicate with patient by email If I have any questions I may inquire with my treating physician

or the Institution Privacy Officer.

Patient signature

Date

Witness Signature _ Date _

Sample Consent Form – Format #2

Institution Family Medicine Patient Email Consent Form

Patient name:

Email:

1 RISK OF USING EMAIL

Transmitting patient information by email has a number of risks that patients should consider before using email These include, but are not limited to, the following risks: a) Email can be circulated, forwarded, stored electronically and on paper, and broadcast

to unintended recipients.

b) Email senders can easily misaddress an email.

c) Backup copies of email may exist even after the sender or the recipient has deleted his or her copy.

d) Employers and on-line services have a right to inspect email transmitted through their systems.

e) Email can be intercepted, altered, forwarded, or used without authorization or

detection.

f) Email can be used to introduce viruses into computer systems.

g) Email can be used as evidence in court

h) Emails may not be secure, including at Institution, and therefore it is possible that the

confidentiality of such communications may be breached by a third party.

2 CONDITIONS FOR THE USE OF EMAIL

Providers cannot guarantee but will use reasonable means to maintain security and confidentiality of email information sent and received Providers are not liable for improper disclosure of confidential information that is not caused by Provider’s intentional misconduct Patients must acknowledge and consent to the following conditions:

a) Email is not appropriate for urgent or emergency situations Provider cannot

guarantee that any particular email will be read and responded to within any particular period of time.

b) Email must be concise You should schedule an appointment if the issue is too complex or sensitive to discuss via email.

c) All email will be printed and filed in your medical record.

d) Office staff and other health care providers may receive and read your messages.

e) Your provider will not forward patient identifiable emails outside of Institution

Family Medicine providers without your prior written consent, except as authorized

or required by law.

f) You should not use email for communication regarding sensitive medical information g) Your Provider is not liable for breaches of confidentiality or any expense, loss or damage caused by you or any third party.

h) Your Provider is not liable for any expense, loss or damage from a delay in the Provider’s response to you due to technical failures.

i) It is your responsibility to follow-up and/or schedule an appointment if warranted.

j) IMPORTANT: It is up to the provider’s discretion to either return your

communication either via email, telephone call or other form of communication

26

3 INSTRUCTIONS

To communicate by email, you should:

a) Avoid use of your employer’s computer.

b) Put your name and contact phone number in the body of the email.

c) Key in the topic (e.g., medical question, lab result, x-ray result) in the subject

line.

d) Inform your Provider of changes in your email address.

e) Acknowledge any email received from your Provider.

f) Take precautions to preserve the confidentiality of your email.

4 PATIENT ACKNOWLEDGMENT AND AGREEMENT

I acknowledge that I have read and fully understand this consent form I understand the risks associated with the communication of email between my Provider(s) and me, and consent to the conditions and instructions outlined, as well as any other instructions that the Provider may impose to communicate with me by email I acknowledge that the Provider may terminate this agreement if I fail to comply with the provisions of this consent form If I have any questions about email communication, I may inquire with my treating clinician or the Medical Director at the health center This agreement shall

remain in effect during the time that I am a patient at Institution Family Medicine.

However, I may change my consent for email communication by notifying the health center in writing of my wishes.

Patient signature:

Date: _

Witness signature: _

Date: _

Please return this form to either medical records in person or

Mail to: Institution Family Medicine Center

XXXX Street

City, State zip

Or fax to: 999-999-9999

SLIDES AND SPEAKER NOTES - PART TWO

The curriculum is divided into two parts The suggested time commitment is one hour for each part This is the second PowerPoint presentation Make sure to print handouts that you may want to use before the presentation (See pages )

2-1

Physician-Patient Electronic Communication Curriculum: PART TWO

Assistant Clinical Professor of Medicine

New York Presbyterian/Columbia University Medical Center

Center for Family and Community Medicine

Part 1: Background, Terminology, Rules and Regulations, Documentation and Informed Consent

Objectives: At the completion of this section, the learner will be able to:

• Define specific terms and guidelines related to physician-patient email.

• Discuss security issues with regard to email.

• Identify guidelines for email communication.

• Complete an informed consent with a patient.

Notes: ACGME competencies: Practice based learning and improvement, Systems based

practice

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Part 2: Appropriate Communications, Problem Situations and Practice Scenarios

Objectives: At the completion of this section, the learner will be able to:

• Understand appropriate electronic communication

• Understand inappropriate patients with whom to communicate electronically

• Understand inappropriate topics for electronic communication

• Recognize how and when to end electronic communication and change to another form of communication

• Critique electronic communication with patients based on presented guidelines

Notes: ACGME competencies: Patient care, Professionalism, Interpersonal and Communication skills, Practice based learning and improvement.

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Conditions for the Use of Electronic Communication

• Patients should be educated about the following:

–Physicians cannot guarantee but will use reasonable means to maintain security

and confidentiality of electronic information sent and received

–Physicians are not liable for improper disclosure of confidential information that is

not caused by physician’s intentional misconduct

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Conditions for the Use of Electronic Communication (cont)

• Patients should be educated about the following:

• Email is not appropriate for urgent or emergency situations The physician

should establish appropriate response times and adhere to these times

• Electronic communication must be concise The patient should schedule an

appointment if the issue is too complex or sensitive to discuss via email