Researchers find ‘major weaknesses’ in current guidelines on emailing with patients

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Current guidelines on using email or secure messaging to communicate with patients are outdated and lack evidence.

Computers and smartphones have changed the way physicians communicate with patients, but industry guidelines overseeing that communication has not kept pace, according to a group of researchers at Indiana University.

An analysis of 11 guidelines covering eletronic communication between physicians and patients found “major weaknesses,” including outdated recommendations, a lack of evidence to support the guidelines and almost no focus on how to use new tools to communicate with patients effectively. Researchers at the Indiana University School of Medicine’s Regenstrief Institute published their findings in a recent issue of the Journal of the American Medical Informatics Association.

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Although the Joint Commission prohibits texting to order treatment, physicians have gradually embraced email and secure messaging apps to communicate with patients. During its annual meeting in June, the American Medical Association said it is considering expanding an existing report on email communication to include text messaging with patients.

But researchers highlighted several flaws in current guidance addressing email, text messaging and video conferencing. For example, privacy and security were central themes throughout all guidelines that spanned general medical providers as well as specialties like psychiatry, neurology and pediatrics. But many of the guidelines, which dated as far back as 1998, included recommendations like encrypting messages and scheduling periodic backups—administrative tasks that are overseen at an organizational level rather than by individual practitioners.  

Very few guidelines included a discussion about how emailing or texting with patients could improve outcomes or utilization, or provided recommendations on how to effectively use electronic communication tools. The authors argued that the prevalence of new communication modalities means physicians could benefit from up-to-date best-practices, the same way they are trained to navigate face-to-face interactions. 

“It may be more helpful for providers if future guidelines focus more on the relational challenges of electronic communication rather than technical issues such as platform specifications,” the authors wrote. “Future work in administrative and technical areas then could expand to include identifying effective messaging practices in the context of health care teams and best practices for how providers could effectively and safely integrate electronic communication into their workflow, two areas largely overlooked by existing guidelines.”