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“Physician-patient electronic mail is defined as computer-based communication between physicians and patients within a professional relationship, in which the physician has taken on an explicit measure of responsibility for the patient’s care.”[1]

[Note: The purpose of this document is not to provide rules on specific issues, but rather to identify concerns that a healthcare provider needs to consider when implementing a new communication technology, such as e-mail, with patients.]

Traditionally, written (paper) and verbal (in person or telephone) communications have been the main means of communicating health information between physicians and their patients. More recently, however, along with their greater reliance upon advanced technology systems to manage office practice functions (e.g. billing, payroll, referrals, medical records, etc.), physicians are increasingly choosing electronic mail (“e-mail”) as an alternate method of communicating with their patients. 

E-mail can be a useful tool in the practice of medicine. It is a relatively simple, convenient and inexpensive application for both physicians and patients.  A few of the benefits of using e-mail, which can help the physician provide quality care, are:

• It facilitates communication with patients since it can be sent and answered at any hour, and it eliminates “phone tag” – the physician and patient don’t need to be available at the same time to communicate effectively.
   
• It facilitates quicker reporting results of diagnostic tests and laboratory studies to the patient, written follow-up instructions and clarification of advice provided in the office can be sent, referral information (phone & addresses) can be sent, educational materials can be provided more easily and (perhaps) at less cost.
   
• It automatically creates a written record of each communication between physician and patient, thus removing doubt as to what information was conveyed.
   
• Frequently used educational hand-outs can be formatted for a practice’s home page, e-mail messages can enable the user to click on a “live” link (URL), which launches a web browser and takes the user directly to indicated resources on particular topics.

While there can be many benefits of e-mail communication, there are also liability issues associated with its use. Potential exposures include, but are not limited to, the following:

• breach of confidentiality of a patient’s personal health information
   
• failure to provide a timely response to a patient’s e-mail, that could result in a delayed diagnosis or diagnostic error
   
• failure to comply with the health information privacy and security rules of the Health Insurance Portability and Accountability Act (“HIPAA”) of 1996 [2]

The following strategies may help reduce liability risks of communicating in this way.  

Content & Privacy

• Develop an e-mail policy that specifies the uses and limits of physician/patient electronic communications.
   
• Inform patients of the policy, so that they are aware of permissible transaction types: prescription refill requests, appointment scheduling and reminders; and inappropriate topics: HIV, mental health-related or other sensitive PHI, etc.
   
• Develop an informed consent form for use via e-mail that includes permissible uses of their patient information; obtain the patient’s written authorization, which should be documented in the medical record with a copy provided to the patient.
   
• Ask patients to enter the category on the subject line of their e-mail message, with name and patient identification number in the body of the message.
   
• Do not send group mailings in which recipients are visible to each other; use blind copy feature; never forward patient identifiable information to third parties without the patient’s express permission.
   
• Inform patients whenever their treating physician is not available; provide the covering physician’s name for those times, noting that he/she may respond to their e-mail.