If you decide you will use email in some form to facilitate communication with your patients, here are some suggestions from the APA:

Use email only for established patients (not new ones) to…

-          schedule or re-schedule appointments

-          provide reminders of upcoming appointments

-          respond to requests by patients for refills of prescriptions

-          provide information of a general nature, such as appropriate time to take medication or the name of the provider covering for you in your absence.

Also recommended by the APA is the creation of an automatic computer-generated response to all incoming emails to your practice, indicating that…

-          you do not correspond on clinical matters by e-mail

-          your response in no way creates a doctor-patient relationship between the sender and you

-          they may not use email for any matter for which they cannot wait at least 72 hours to be addressed.

In other words, you need to ensure that the patient understands that any email to or from you or your practice does not constitute a medical/therapeutic intervention and is not intended to render any type of clinical service other than to provide a convenience for more routine matters. These communications are not a substitute for an in-person visit.

What other kinds of issues should be reserved for a face-to-face patient encounter rather than in an email? 

-          Concerns relative to one’s intent to harm himself or another

-          Emails that contain protected and sensitive personal patient information (such as HIV issues, Drug and Alcohol, names/identities of third-parties)

-          Requests for a first or initial appointment 

You will want to consider tracking the number and kinds of emails from your patients over a specific period of time for quality purposes. If it appears a patient is using internet services in lieu of face-to-face encounters for therapeutic or clinical purposes, you will want to counsel the individual that email is a convenience and privilege to foster timely communication, and is not to be regarded as a substitution for one-on-one appointments that promote a stronger therapeutic alliance.

To summarize:

-          Be proactive and decide just what role email communications will have in your practice.

-          Decide how you will educate your patients regarding appropriate use of email when communicating with you. When to provide this education is important – the initial patient encounter is recommended.

-          Decide the means by which you will educate patients about your email policy, especially with respect to issues of confidentiality and privacy. Then have them demonstrate understanding and acceptance of your practice policy with respect to email.

-          Determine what steps you must take to protect the information entrusted to you and how this information is stored, shared, utilized and, ultimately, destroyed.

For a better understanding of the far-reaching impact email can have on your practice, refer to the article Walking the Tightrope of the New Electronic Discovery Rules by James Couch, M.D. also appearing in this month’s Risk Review.

Once you’ve established the criteria and have developed a policy addressing email use in your practice, determine how best to communicate this policy with your patients. Perhaps a statement on the back of your patient appointment card is best and most convenient. If you have a practice brochure, include your policy statement with regard to email use somewhere in this printed material. A simple, informed discussion, properly documented in the record, or a short form memorializing the discussion and acknowledged in writing by the patient, will help standardize your patients’ expectations for the future.