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Electronic Communications

Email Security for the Healthcare Industry: A Proposal for Collaboration in Wisconsin (Word document format) whitepaper from the HIPAA Collaborative of Wisconsin (HIPAA COW).

Patient Experiences and Attitudes about Access to a Patient Electronic Healthcare Record and Linked Web Messaging, Journal of the American Medical Informatics Association, November/December, 2004
Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.

The role of primary care non-physician clinic staff in email communication with patients
Few studies have explicitly addressed how email technology may affect non-physician clinic staff, even though these staff typically manage tasks well suited to email communication such as requests for prescription renewals, laboratory and test results, and referral authorizations. This study found that in order to maximize the potential of staff–patient email, it is important that concerns relating to security, confidentiality, and workflow are addressed, and patients must be given guidelines for the appropriate use of email. Secure applications designed with these issues in mind are likely to be well received by staff members, and in turn physicians.

eRisk Working Group on Healthcare's Guidelines for Online Communications address liability issues related to general online communications and those specific to fee-based online consultations

Secure email messaging & HIPAA resources from Zix Corporation:
  • HealthyEmail is a physician outreach program offering a secure email communication tool at no-cost to all US physicians, including office staff.
"Email Privacy" audio conference presentation handouts from the International Association of Privacy Officers, April 24, 2002:


"Electronic Message Archiving" white paper (PDF)
by Ferris Research for Baltimore Technologies
it is clear HIPAA regulations will require all creators and receivers of electronic health records to maintain strict privacy and access controls. In the case of email, it seems likely that some type of archiving strategy will be required for compliance.

AMA Recommended Guidelines for Physician-Patient Electronic Communications

AMIA White Paper: Guidelines for the Clinical Use of Electronic Mail with Patients

Journal of AHIMA--Practice Brief: Email Security

Fax Facts on sending and receiving faxes that contain PHI.


Articles

Best Practices For Building An Encrypted (But Accessible) EMail Archive by Kelly Jackson Higgins, InformationWeek, September 8, 2005
Regulatory and legal pressures are forcing many companies to encrypt their email and other archives. But can they decipher those messages or that data when they need to? We tell you how.

You've Got Mail: Email Encryption is Becoming a Necessity for Protecting Sensitive Information by Paul McNamara, Network World, August 15, 2005
The sheer volume was the shocker. Cliff Gobin had figured it would be maybe a few dozen e-mails a month - only those carrying confidential patient information off the network - that would need to be encrypted once his hospital rolled out a secure-messaging capability to employees and affiliated physicians. The actual number of e-mails being encrypted today: 1,000 to 1,500 per month.

Digital Doctors by Ann Geracimos, the Washington Times, January 13, 2005
Here at the the Washington ENT Group in Washington, DC, computers play a direct role in patient care, but issues involved in protecting patient privacy restrict certain kinds of communication. For the most part, doctors do not return e mail requests from patients about medical matters because they cannot be sure who is actually making the request and why, but this is decided on a case-by-case basis.

Time Spent on Email Concerns Many Doctors by Kelli M. Dugan, Birmingham Business Journal, November 7, 2004
Without a reimbursement system ensuring physicians their electronic time is valued at least on par with their billable time, local doctors doubt adopting the technology will be worth the effort or the compromised patient privacy.

Email Management: The Curse of the Killer App by Carol Hildebrand, SearchStorage.com, October 27, 2004
For many organizations, regulatory compliance laws have mandated a closer look at how they manage email. From HIPAA to the Sarbanes-Oxley Act (SOX), regulatory insistence on the ability to retain and quickly retrieve valuable data grows more common.

You've Got Mail by Douglas Kamerow, Editor, British Medical Journal USA edition, October 16, 2004
In an interview with BMJ USA, National Health IT Coordinator David Brailer, MD, PhD, says that email is an essential component of clinical care, although he concedes that Medicare does not currently reimburse doctors for email consultations. An editorial by Steven Waldren and David Kibbe, both of the American Academy of Family Physicians' Center for Health IT, "Email in Clinical Care," says that email can best be used as part of a fully electronic health record, arguing that stand-alone applications are an invitation for errors. They also point out that the standard email being exchanged today between doctors and patients fails to meet necessary standards for confidentiality.

Wall Street Journal Examines Physicians’ Reluctance to Email Patients, iHealthBeat, June 3, 2003
While doctors are accepting their patients’ use of the Internet to find health information, many are reluctant to take “the next step with virtual doctoring” by communicating electronically with patients, according to the Wall Street Journal. Physicians fear that using email to provide medical care could expose them to more malpractice suits, violate the HIPAA privacy regulations and “change the doctor-patient relationship for the worse," the Journal reports.

Top 10 Tips for Setting a Secure Communications Policy by Ken Beer, ComputerWorld, January 22, 2003
Employee misuse of corporate e-mail has been a source of liability for numerous organizations, and many are now moving to develop policies that define appropriate usage. Businesses are also increasingly adopting policies to ensure that government regulations are met, sensitive business data is secure and customer privacy is protected. Here, in no particular order, are the top 10 things IT policy-makers should consider when developing corporate email policies.

Email Connects Patients, Doctors by Sarah A. Webster, The Detroit News, September 2, 2002
According to iHealthBeat, the Detroit News reports Henry Ford Health System is piloting a Web-based patient-physician communication project in a move to increase efficiency and convenience for patients and physicians. Patients can request prescription refills, receive tests results and ask physicians questions through personalized Web pages that use a secure messaging system. Typically within 24 hours, physician responses to patients’ questions are posted on patients’ individual password-protected Web pages; the system automatically notifies patients via email when their page is updated.

Medicine by Email Grows by Jan Jarvis, Dallas-Fort Worth Star-Telegram, August 6, 2002
Many doctors have been reluctant to hang their shingle at a virtual office because of privacy concerns, but more and more are turning to technology to improve the way they practice medicine. Some health professionals are so unsure about how HIPAA will affect medicine that they are steering clear of online services.

Doctors Resist Emailing Patients by Katie Hafner, New York Times News Service, June 10, 2002
As Internet use became commonplace, some experts held up email as a promising new medium for communication between doctors and patients. But reality has fallen short of the predictions. Physicians, it turns out, are largely reluctant to exchange email with patients.

Get a Grip on Email Security: What are the options for fulfilling the HIPAA email encryption rules? by Robert Voelk and Ann Geyer, Healthcare Informatics
Email has quickly established itself as the dominant communication method in the workplace. But in the healthcare industry, the broad implications of the HIPAA requirements regarding email's implementation and management are poised to disrupt its use.

Secure Messaging Strategies for Healthcare IT Professionals by Ken Beer
With the final HIPAA privacy regulation issued, healthcare IT professionals now must determine how to best ensure the confidentiality of patient records as they move between healthcare constituents across multiple networks.

Email patients? Don't be nervous. Do be careful by Ken Terry, Editor, Managed Care magazine
Yes, you need to be cautious and set up a secure system. But liability risks are much less than many doctors fear, say experts.

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