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San Francisco Marin Medical Society Blog

When Email Is Part of the Doctor's Treatment

Patients love it. Physicians find it often saves them time and money. So why aren't more doctors burning up the email lines with their patients? 

As the rest of the world has raced ahead with instant communication, medicine still lags far behind. Just under one-third of doctors reported emailing with patients in 2012, up from 27% five years earlier, according to annual studies of more than 3,000 doctors conducted by Manhattan Research, a health-care market-research firm. Those texting rose from 12% in 2010 to 18% in 2012.

Doctors who shun email cite concerns ranging from privacy and security issues to liability, inconvenience and the risk of miscommunication of important medical information. Some also say the time spent emailing with patients is time unpaid. Few doctors charge for the service.

Groups like the American Academy of Pediatrics' Section on Telehealth Care are working on developing initial guidelines on how to deal with electronic communication. Guidelines will address issues such as patient privacy and medical safety.

Those who do email say it is a convenient way to communicate with patients without the hassle of playing phone tag, and that it can keep patients from relying on Google searches that can sometimes lead to inaccurate information.

Jocelyn Bonneau of Manhattan generally asks her doctors up front if they give out an email address. The barriers to actually speaking with a doctor "can be frustrating," said the 28-year-old financial analyst, who said she sometimes will "just give up and Google [my symptom] or just say, 'I'll get better,' and that's probably not the best way." Being able to email with a doctor, like her endocrinologist Andrew Martorella, makes a world of difference, she said.

Dr. Martorella said his patients email him to get blood-test results, refill prescriptions or to say they're running late. He estimates he gets up to 40 or 50 a day, which can take a few hours to respond to. Without email, he said he would probably need at least one extra person on staff to field patient phone calls: "I think it is definitely made a big change in terms of reducing costs, especially for solo practitioners."

Dr. Martorella ends new-patient visits by asking if they'd like to communicate via email. If so, he asks them to sign a form agreeing to electronically communicate about health matters and giving him authority to discuss medical issues over email. The form, he said, ensures that he's in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA) designed to protect the privacy of health information. HIPAA compliance is the main concern raised by doctors who don't email.

The law requires that electronic communication related to an individual's health is protected and secure, said Jane Thorpe, an associate professor of health policy at George Washington University. If someone communicates protected health information electronically through a phone or other mobile device, Ms. Thorpe said, "it needs to be in a secure system," such as one that encrypts messages or through a secure portal. Personal email such as Gmail, she said, is "absolutely problematic."

As part of the federal government's stimulus act, physicians are being encouraged through financial incentives to use electronic medical records. One part of that effort includes the use of secure messaging to share health information with patients through, say, an online portal.

Source: The Wall Street Journal, March 26, 2013

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