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

23 Electronic Mail in Pediatric Practice 317
Answer/ask questions
Provide/get additional information
Discuss symptoms
An analysis of 81 e-mail messages within a pediatric office 11 revealed (Table 23.2):
The response type frequencies were (Table 23.3):
Table 23.2 Types of e-mail requests in a
pediatric office
Table 23.3 Responses to e-mail from a
pediatric office
Type of request %
Medical question 53
Medical update 25
Subspecialty follow-up 11
Administrative request 11
Type of response %
Medical guidance 63
Phone call 10
Prescription 16
Subspecialist referral 2
Administrative paperwork 5
Appointment 4
23.6.2 Chronic Disease Management and Privacy
A pediatric office decides to send an e-mail alert (message) all the asthmatic patients in
the practice to let them know that the office has influenza vaccine and all patients with
asthma should call to come in for their yearly immunization. One e-mail “flier” is sent by
e-mail to multiple patients utilizing the office’s “asthma group e-mail address list”.
Patients are happy to get notice – until they recognize that they can see the names and
e-mail address of every asthmatic in the practice, and realize that this information about
themselves is visible to all the other recipients of the mass e-mail.
Situations, similar to that above, occur commonly. Such errors, including inadvertent
transmission of a patient’s diagnoses, are a breach of privacy under HIPAA and are
subject to regulations on penalties and disclosures. Another privacy issue relates to
staff access to patient e-mail messages intended for a physician. In some offices
a nurse or clerk may read all incoming e-mail and triage billing questions to the
office, appointment requests to front desk and medical questions to the physician.
These are part of practice operations, and patients sending medical questions
specifically to their physicians should be aware that office personnel may read and
act upon their question before or on behalf of the physician. Clear office privacy
policies must be in place, and staff must adhere to them as part of their employment
contracts. Patients using e-mail must be informed of practice policies and procedures
regarding e-mail: HIPAA regulations, “Do’s and Don’ts” and expectations
before e-mail use with the practice is allowed. The use of secure messaging and/or
reimbursed e-mail services 12 may streamline some of these tasks.