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Topics : e-Visits

Expert Advice:
e-Visit Best Practices and Risk Management Tips

By Joseph E. Scherger, MD, MPH

Joseph E. Scherger, MD, MPH - portrait

E-mail is an efficient method of communication in your medical practice, but standard email services do not meet HIPAA requirements. The bottom line basic for e-Visits is to ensure that your practice's online communications with patients are encrypted. One good option, especially for AAFP members, is via a secure web portal such as Medfusion.

You'll also want to get acquainted with the eRisk Guidelines developed by the eRisk Working Group for Healthcare and the AMA's Guidelines for Physician-Patient Electronic Communications. These guidelines articulate a host of valuable best practices for electronic communications that will benefit every practice.

The guidelines carry no formal legal authority but do suggest some of the safest ways to practice medicine online. Following established guidelines such as these will enhance quality of service for your patients and reduce the liability exposure of your practice.

Consider the following measures to minimize the chance of problems arising from e-mail interactions:

  • Offer e-mail "visits" only to existing patients whose medical history you are familiar with, rather than to patients you have never treated.

  • Keep complete records of your email exchanges. One of the benefits of e-mail is that it documents exchanges between physicians and patients. If you are not currently using a portal or similar service designed to automate e-Visit record-keeping, this might mean including a copy of messages in the patient chart, copy-and-pasting them into electronic health records, etc.

  • Develop Terms of Service, Informed Consent, and other legal documents with your professional legal counsel.

  • Be up-front with patients about fees, services and "the ground rules" of email exchanges.

  • Establish an explicit turnaround time for messages (e.g., 24 to 48 hours).

  • Some states have specific laws prohibiting certain classes of health information from exchange via email-- regardless of patient consent. Know and follow the laws in your state. Click here for links to state resources in "E-visit Resources".

  • Use a disclaimer. A standard disclaimer appended to the footer of your emails could read as follows:  “Electronic mail is not secure, may not be read every day, and should not be used for urgent or sensitive issues.”

  • Clearly differentiate between online consultation for an existing condition and online diagnosis and treatment of new conditions. Develop and implement policies for each type of interaction. 

  • If you exchange e-mails two or three times on an issue, or encounter a communication or emotional issue, recommend that the patient schedule an appointment.

  • Always clearly communicate follow-up plans and "next steps" to patients. Make sure you have a method for tracking follow-up.

  • If you provide links to patient education content sources or online services, it is your responsibility to assure that the resources are recognized, credible and authoritative.

  • Communicate professionally and politely — Never say in an e-mail what you wouldn't say in person.

  • Avoid sarcasm, irony and jokes — no matter how good your relationships are with your patients. Health care communications should be clear, concise and professional.

  • Never use abbreviations with patients.  Limit your use of abbreviations in e-mails to close friends or associates.  To the average patient, abbreviations most often lead to confusion.

  • Check spelling and evaluate your grammar before clicking the "send" button.  Misspelled words and poor grammar, even in an e-mail, reflect poorly on you as a professional.

  • Append a standard signature text block to each message that includes (at minimum) your full name, your contact information and information about security of the email exchanges.

  • Inappropriate uses of secure messaging include medical emergencies, time sensitive issues, communication of bad news, and sensitive issues.

Also see:

Dr. Scherger's Online Communication With Patients: Making It Work in Family Practice Management.

The eRisk Working Group for Healthcare's eRisk Guidelines for Online Communication

The AMA's Guidelines for Physician-Patient Electronic Communications


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