Pediatric Informatics: Computer Applications in Child Health (Health ...

314 R.S. Gerstle
PHO, HMO, or medical society. In such arrangements, connections are protected
and messages are encrypted through standard protocols prior to transmission. Thus
physician–physician communications for referrals, consults, follow-up, or general
questions can be made relatively securely and simply within the confines of that
network.
Where e-mail communication between physicians occurs between networks,
such as between different medical centers, a Virtual Private Network or VPN (to
connect external physicians to those within a network securely) may be established
to comply with HIPAA regulations when a sufficiently high volume of information
is exchanged between centers.
In addition to encryption, messages may be sent as password-protected e-mail
attachments. Passwords may be assigned through standard word and document
processing tools or through software designed specifically for such a purpose.
Sender and recipient need to have the software tools and knowledge of the password
(or key). The method of protection and the strength of the security depend on
the sensitivity and importance of the information.
23.3.2 Organization and Personnel Issues
The handling of e-mail containing PHI once it has been received is equally
important in security. Defined procedures on handling e-mail: who may access it
(physicians only, nurses, clerical personnel), where they may access it (at work
only, at home, on mobile tools), what they are prescribed to do with it (print, save,
delete, forward via e-mail, file with the record) are needed, with an audit trail for
tracking messages. Increasingly, EHR vendors are integrating e-mail modules into
their products to improve productivity.
Other organizational issues include handling permissions for employees who
leave the practice and adequate training of new employees charged with handling
clinical e-mail messages. Periodic review of procedures is needed to assure due
diligence in considering security and efficiency of e-mail practice.
23.4 Issues in Improving Access, Quality, and Revenue
with E-Mail
23.4.1 Access
Although e-mail is ubiquitous, a “digital divide” may exist between “the haves
and the have-nots.” Barriers to e-mail accessibility and usability may include lack
of access to: computers, Internet access and e-mail, computer and health literacy,
adequate language or typing skills, and ability to receive responses. For the poor