We have noticed a surge in queries from our clients about the use of SMS and email for patient communication, in particular recalls and reminders.
The trend stems from a number of factors such as patient preference, technological efficiencies and increasing postal costs and delays.
The Royal Australian College of General Practitioners (RACGP) Standards for General Practice acknowledge that patients are able to obtain advice or information related to their clinical care by telephone or electronic means where the doctor determines that it is clinically safe and that a face-to-face consultation is unnecessary.1
The RACGP’s standards provide the following useful guidance for medical practitioners2:
- Obtain and document patient consent before health information is communicated by email or SMS
- Confirm a patient’s identification and verify the patient’s contact details before any information is sent
- Consider whether it is appropriate to communicate particular information by electronic means or whether other methods would be more suitable (e.g. for sensitive information such as HIV status or pregnancy results this mode would not be suitable)
- Conduct communications with particular regard to privacy and confidentiality considerations given the higher risk of information inadvertently being seen by another person
- Have a documented process for ensuring that electronic messages from patients are recorded and given to the person for whom they are intended on the day of receipt, or in that person’s absence, to the person who is providing cover.
Parameters of use and patient consent
Bearing in mind the above considerations, medical practices should have a policy on the use of electronic communication with patients to ensure consistent use among their staff. The policy should cover:
- How patient consent is obtained and documented
- What checks are made to verify the patient’s mobile number/email address is up to date and accurate
- What type of information can be included in an SMS or email
- Who is authorised to send/receive and respond to SMS and email
- How electronic messages from patients are dealt with in the recipient’s absence
- The process for recording electronic messages in the patient’s health records.
Similarly, the practice needs to convey sufficient information about the electronic communication service which is available to obtain the patient’s informed consent.
Obtaining the patient’s consent could be as simple as including a question in the patient registration form, on-line appointment or registration portal seeking the patient’s consent to use SMS for appointment reminders and recalls or it could be a more comprehensive consent form covering various options for electronic communication which needs to be read and signed by the patient.
The best method of obtaining the patient’s consent will largely depend on the extent of the service being offered. The key is ensuring that the parameters of the service are clearly communicated to the patient.
Importantly, if a patient does not consent to being contacted by SMS or email then that should be clearly documented to ensure that SMS and email messages are not inadvertently sent.
Factors to consider
- To safeguard against the risk of confidential information being accessed inadvertently or intentionally by a third party, the SMS or email should not divulge sensitive health information (e.g. a test result) unless the patient has provided express consent
- Emails are only safeguarded against unauthorised access if both parties have the appropriate encryption programs on their computer. Patients must be aware that the practice cannot guarantee confidentiality of information transferred via email
- With appropriate consent, an SMS or email can be used to effectively communicate:
- A reminder for a scheduled appointment (time and date)
- The need for a patient to make an appointment to review a test result
- A reminder that a generic preventative screening test (flu vaccine, skin check, pap smear) is due
- When recalling a patient for a test result, the extent to which patients are followed up will depend on the level of urgency and the clinical significance of their test results. If the patient has not responded to the SMS or email, then other forms of communication (phone call, registered mail) should be considered
- Email and SMS messages between the practice and the patient form part of the medical record and need to be included. Some electronic health record systems can perform this feature automatically.
If you have any concerns or queries about the use of electronic communication in your practice, please contact one of the solicitors in the Claims & Legal Services Department for further advice.