Use of email

Email is an easy way for patients to communicate with the practice, and the demand for such a service has increased over time.

Safeguards are required in order to preserve patient confidentiality. Unless messages are encrypted, patients should be aware that their messages could potentially be read by someone else.

Only appropriate matters should be dealt with via email exchanges, eg appointment scheduling, ordering repeat prescriptions and obtaining test results. A standard protocol for email exchanges could prevent emails from patients asking for more complex information about medical symptoms or their proposed treatment, which would be difficult for the practice to respond to quickly and appropriately.

It is important to ensure that all emails to and from the patient are included as part of the patient’s medical record.

Do:

• Ensure that there are appropriate levels of encryption.
• Liaise with your IT provider to ensure that appropriate safeguards are in place and information on the clinical system remains secure.
• Have an automated acknowledgement, in the form of a response indicating that the email has been received, when the patient should expect to receive a reply and a recommendation that they should contact the practice directly if the matter is urgent.
• Monitor email enquiries at regular intervals and ensure that they are promptly brought to the attention of the relevant person.
• Respond in a professional manner and, in particular, avoid “textspeak”.
• Give consideration as to whether or not you wish to respond from your personal (as opposed to the practice) email address and, if so, you should ensure that there is a mechanism in place to deal with enquiries that arrive whilst you are on leave or away from the practice.

Do not:

• Forget that email exchanges are an important part of a patient’s medical records.
• Underestimate the amount of work that is likely to be involved in both setting up and maintaining such a system.
• Forget that many of the subtleties of communication, including non-verbal cues, are lost when communicating by email.
• Use email to respond to complicated or difficult problems.
• Forget to set aside some time in the working day to respond to email enquiries.
• Forget to have robust procedures in place to follow up any matters that arise from an email exchange.

Use of text messaging

Text messaging allows practices to target and contact hundreds of patients within minutes. Patients can respond by text with replies automatically forwarded to a specified email address. Many practices are signing up to using a text messaging service to inform patients of appointments, flu vaccinations etc.

How is consent taken?

Do not assume that just because you hold the patient’s mobile telephone number on the patient’s record, they have provided consent for text messages to be sent. Only send text messages to those patients where consent has been recorded for you to undertake this form of communication.

During an appointment or other communication, ask the patient if he/she would be happy to receive a text message via mobile phone, eg. for an appointment reminder.

The patient’s consent or refusal must be clearly recorded on the patient’s computer record where it is easily visible. Patients who consent should be advised of the importance of informing the surgery of any changes to their contact details.

This is important because patients may change their mobile phones at regular intervals, and if they choose to give their old phone to a friend or family member there is obvious potential for a breach of confidentiality. The consent should be revisited and updated at regular intervals.

What should practices be wary of?

Whilst the use of text messages can offer greater convenience and flexibility for patients and doctors, it is essential for practices to review the systems in place relating to this. This is to ensure that they are as secure as possible and compliant with the relevant legislation and professional guidance. Remember that text messaging in this context is a professional communication, hence “textspeak” should be avoided.

What information needs to be provided?

Inform patients of the practice’s text messaging service and the limitations, via the practice leaflet, website or notice in the waiting room. The leaflet could be given to the patient when they consent to receiving text messages. The content of the leaflet should be reviewed at regular intervals and adapted to reflect any changes in the service and/or advances in technology. Have a policy that covers alternative means of communication, such as text messaging, and ensure that is reviewed regularly and updated consent is kept in the patients’ records.

Does it form part of the medical record?

The text message would be considered part of the patient’s medical records, hence it is important that the consent for the text message is recorded in full, as well as the date and time that it was sent and the content of the message. Any response received should also be recorded in the patient’s record in the same way.

What information is not appropriate to send by text message?

Be careful about the information contained in text messages; in general terms, text messaging lends itself to sending out generic reminders to specific target groups. However, it is not an appropriate way to deal with clinical queries and patients should be made aware of this.

Practices should not rely on text messaging alone in relation to the issuing of reminders; it should simply form part of a wider strategy.

There is a risk that patients may respond to the text and seek other information (for example, clinical advice). Careful consideration should be given to this potential problem, particularly given that there is a possibility that a patient may seek urgent advice outside the practice opening hours.