Medical Staff Informational Sessions

1

Physician-Patient Email Communication (TSBME
Chapter 174 Telemedicine)

• Medical Staff Informational Sessions

Jim Kelso, JD, LLM (Health) Chief Privacy Officer
301 University Blvd. Galveston, TX
77555-0198 409.747.8706
2
General Disclaimers

• This is an untested temporary policy solution.
• Licenses may be at risk.
• Some chairs are not willing to allow for the
  risk.
• All email communications must become part of the
  official UTMB medical record.
• This applies to any patient regardless of whether
  the patient is a UTMB employee or not.
• Email is not considered confidential and patients
  must understand and agree to this lack of
  confidentiality (TSBME requirement).
• Read the policy and the agreement and require any
  support staff to do the same.

3
Procedure under IHOP policy (9.2.20)

• There are three main requirements for adhering to
  the policy
• Informing the patient of the rules for email use
  by having the patient and the provider sign the
  email agreement.
• Both the provider and the patient have
  obligations and responsibilities.
• Authenticate that the person sending you the
  email requesting medical advice is the patient.
• Documenting the correspondence in the medical
  record.

4
Agreement for UTMB and Patient e-Communication

• Prior to emailing with a patient the following
  must occur
• The patient must sign the Agreement,
• The Agreement must have the patients full name
  and the patients Unit History Number (UH)
  before being sent to the patient.
• It must be returned in person or via fax,
• The provider must sign the Agreement, and
• The Agreement must be sent to Health Information
  Management (HIM) for filing.
• Patients full name and UH Requirement
• The reason this is required is because the
  patient must include this information in all
  emails sent to the provider.

5
Authentication Requirement

• The TSBME requires providers authenticate the
  person corresponding via email is the actual
  patient. Therefore the provider must
• Verify the patients identity by cross
  referencing the patients UH and the patients
  email address.
• The patient must include the UH in the email as
  required by the Agreement.
• Use and update the authentication log or use the
  Microsoft Outlook Contacts for authentication
  before replying to any emails.
• These logs must be available to providers at all
  times.
• If the verification is satisfied, the provider
  may respond.

6
Copy of the paper log
7
Outlook Contacts is another option for tracking
patients for the verification requirement. For
remote access (access from the web) contacts must
be saved anywhere but on the providers C drive.
Check with your IS rep to make sure your
contacts are saved on your H or S drive and
that you can access them by logging into your
email from the web. This what contacts looks like
when you select it in Outlook.
8
Outlook Contacts To add a patient in your
Outlook Contacts select new contact in upper
left. Just like when sending a new email
message. You can have your assistant create
contacts for you after the Agreement has been
signed by both the provider and the patient.

9
Outlook Contacts This is what a new contact
looks like. Here someone adds in the UH number
in the big text box on the right and the email
address in the upper right email box. When
finished Save and Close. When verifying
identity, you check the email address and UH
number recorded in the contact and compare it
with the email address provided by the patient in
the text of the email received. If they match,
you are able to respond to the patient.
10
Outlook Contacts This is what a patient contact
would look like after all the information has
been included.
11
Documentation Requirement

• At the close of all dialogue, the provider must
  send a copy of the correspondence to HIM.
• This can be done in paper or electronically.
• If sent to HIM in paper, use the traditional
  process in place to forward information to HIM
  via interoffice mail.
• To send electronically, forward the message to
  HIM by sending it to HIM.emailfiling_at_UTMB.edu.
• For those that use Practice Partner, it is
  appropriate to cut and paste into practice
  partner.

12
Topics for Email Communication

• Email communication should be used to address
  administrative issues, relay follow-up
  information, and answer questions following a
  face to face evaluation. The following topics
  are considered appropriate for e-mail
  communication
• Prescription refills
• General medical advice after an initial face to
  face visit
• Lab test results
• Appointment requests for non-urgent problems
• Simple treatment instructions
• Patient education to improve health literacy
• Examples of inappropriate topics may include
• Discussion of HIV status
• Workers compensation claims
• Urgent matters are not appropriate for e-mail
  communication

13
Additional Comments

• Emails are considered as a formal letter to the
  patient. Email lends itself a sense of informal
  conversation and providers must be aware of
  inappropriate informality.
• All emails between providers and patients must
  include in the header or footer or at the end of
  the email the following
• To my patients, please note email is not
  necessarily confidential and should be used for
  routine matters only. Urgent or emergent issues
  should be handled by telephone. Emails may not be
  read in a timely manner if I am out of the
  office. If you have not received a response
  within two (2) business days, please contact my
  office at insert office number.

14
Questions or Comments