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

322 M.M. Simonian
and concerns about the reliability of patient use of e-mail. 6,7 In general, physician
resistance to use e-mail with patients has been high, except in individual practice
groups and associations.
Advantages of e-mail over telephone include its asynchronous nature, which
reduces “phone tag” and can be used as appointment reminders (which in conjunction
with patient self-scheduling can reduce no show rates) (reference to reduced
no show rates). E-mail also allows options for templates for answers for common
questions that allow readers to “drill-down” to online information libraries
(via embedded hyperlinks). 8 Some EMR vendors are exploring ways to coordinate
e-mail messages with clinical content such as lab tests and consultation requests
and integrated patient information services (i.e., personal health records) through
online practice portals. 9
One concern in adopting patient care ICT is its conformance to the Health
Information Portability and Accountability Act (HIPAA) privacy rules with regard
to security and management of protected health information (PHI). Physician
groups and IT vendors have collaborated to develop Web and e-mail techno logies
and standards that conform to HIPAA, and the AAP has recently updated its
guidelines on the use of e-mail with patients. 10,11
An online modality specifically developed to address these concerns is secure
messaging, an online system for registering and tracking all electronic communications
between patient and provider for documentation and reimbursement 12 through
secure Web technology that meets HIPAA requirements. Secure messaging allows
(and restricts) viewing of an online communication to a specific sender and receiver
of a message, a security restriction that is not possible with traditional e-mail.
Secure messaging limits access to a message to its sender and intended receiver by
encryption (encoding or scrambling a message so that it cannot be read by others)
and decryption (decoding or restoring a message for reading). Secure messaging
conforms to HIPAA standards for privacy and security and may be used by patients
to schedule appointments, to request prescription refills and/or to ask questions to
and receive answers from their providers.
In adopting and using secure messaging (or any form of ICT for patient
communication), pediatricians (and other health care providers) must ensure that:
(1) the recipient of an electronic message has a legitimate right to access the contained
information, (2) the message is transmitted only to the intended recipient,
and (3) the information is accurately transmitted and received.
Despite the availability of tools and guidelines to circumnavigate the medico-legal
aspects of its use and the recommendations of satisfied physician and patient users,
there has not been enough incentive to make patient–provider e-mail a widespread
practice. Currently, only a limited number of insurers reimburse e-mail consultations.
In situations where non-compensation is less of a barrier (such as salaried
clinicians or fee-for-service reimbursement), positive return on investment (ROI)
and improved quality of care have been noted by those holding responsibility for
the costs of care. The federal government’s recognition of the great amount of work
done outside the office has generated efforts to outline recommendations for payment
mechanisms for such services as e-mail consultation and communication. 13