E-mail is Swell, But are You Ready For It?
from Practice Update, Winter 2007
Elizabeth W. Woodcock, MBA, FACMPE, CPC
Email is a great way to communicate with your patients’ parents or guardians. It promises fast, personal response. But can you and your practice live up to that promise? Here are some issues to consider if you are thinking about letting parents send e-mails to you or your staff.
Security
E-mail is not secure. Messages can go astray and you don’t really know who on the other end may see your return message. Many people send personal e-mail from work but are not aware that employers may legally access employee’s e-mail. The Health Insurance Portability and Accountability Act (HIPAA) doesn’t prohibit patients – or their parents – from sending you their protected health information (PHI) but medical providers must take certain precautions when initiating or replying to those messages. Secure messaging is the answer, but this technology will likely require you to set up a secure Web portal. Vendors like www.medem.com and www.medfusion.com are among those that offer secure Web portals that allow e-mail encryption at an affordable price.
Reimbursement
E-mail is not yet billable to most insurance companies. Some physicians bill directly for using this electronic communication option as a non-covered service. If you plan to do so, make it clear to parents and guardians upfront that you will expect payment, how much that service will cost, and what you will – and will not – handle via e-mail. Try to collect payment at the time of the communication via a secure payment service such as PayPal; otherwise you will incur the usual costs and delays for billing and collecting those payments via surface mail.
Limits
E-mail is not a one-time communication. It often sets off a series of communications back and forth as the parent or guardian asks follow-up questions or requests clarifications. Consider setting up a messaging system that doesn’t accept replies – and make this policy clear to the parents or guardians who use it. Of course, this may devalue e-mail as a chargeable non-covered service to those parents or guardians who want a direct communication link to you.
Access
Physicians should be wary of creating e-mail addresses that are easy to guess. If a parent or guardian sees that staff members’ e-mail addresses listed on your website all follow the pattern of “employeename@yourpracticename.com” it won’t take long for someone to correctly guess your e-mail address. Avoid this problem by funneling e-mail communication with the outside world through your secure messaging system.
Expectations
If you decide to communicate with patients’ parents or guardians electronically, define what topics you’ll handle and the timeframe you’ll pledge to meet. Set up an automatic reply message that confirms the message has been received, states when they will hear back, and instructs users to call the practice or 911 if their child’s medical matter is urgent. Explain how messages received after office hours or on weekends are handled. Some primary care providers explain that they will only answer their e-mails twice a week. This reduces expectations of swift response. Be sure to instruct parents and guardians likewise about whether you will process requests for prescription renewals, test results, etc., by e-mail. Some PCPs set up a special e-mail box for these incoming requests for staff to sort out. Others have a website capable of handling these requests securely. Set expectations also for your return communications. If the matter is one that should be communicated in person (like, “what’s my child’s biopsy result?”), skip the e-mail and call the parents or guardians to ask them to come in for an appointment.
Triage
Appoint someone to triage incoming messages, be accountable for their resolution, and if necessary hound recipients – including you – to reply on time. Otherwise your practice’s e-mail inbox will become a black hole into which messages disappear forever. This screening and shepherding also will prevent you or the other primary care providers from being deluged with correspondence that should be handled by the billing office or other administrative personnel.
Ask
Survey parents and guardians to see how many are interested in communicating with you by e-mail. Once you start using e-mail, survey users by e-mail to see how the service is working.
Many practices wade into e-mail by using it just for billing inquiries or to complete prescription refill requests, either of which can significantly reduce staff time spent handling these tasks. Again, be sure to use a secure system that encrypts the e-mail.
Make sure to let parents or guardians who send e-mails know if their message will be handled by a PCP, nurse, receptionist or another staff member. And, again, make sure an automated reply explains your policy on handling e-mailed medical questions (some parents or guardians may tack a question about their child’s health on to an inquiry to the billing office).
A secure website portal that requires users to first be granted access privileges by your practice and to use personal passwords is the safest and most efficient way to handle e-mails and stay within HIPAA rules. Even then, you won’t know for sure which parent is accessing the e-mail system or if it is the child or even a sibling in the household who is doing so – most people are pretty loose with passwords and pin numbers around close family members. Many vendors of electronic health records offer secure Web e-mail as do some practice management system vendors – even a few answering services are getting into the act. Whatever option you choose, set clear expectations and define the limits for communicating with parents and guardians by e-mail.
