Table 1.

ACP Recommendations for Electronic Communication Between Patients and Physicians

ACP Position/recommendation	Actions	Rationale
1. Electronic communication can supplement in-person interactions between patient and physician	• Communicate electronically with patients who have established care in person and maintain an ongoing in-person relationship • Be aware of local laws and institutional policies regarding the use of electronic communications	• E-communication should only occur within an established patient-physician relationship to ensure adherence to professional standards • Regulations pertaining to e-communication and consultation vary by state
2. Electronic communication should only take place after discussion with the patient about expectations and appropriate uses, and with the patient’s consent	• Discuss risks, benefits, and expectations with patients. Patients should consent to use • Share a printed or electronic copy of your practice or institution’s policies and procedures with your patients • Know and follow your practice or institution’s communication, medicolegal, and administrative guidelines	• Try to align patient and physician expectations for communication (i.e., response time for messages, appropriate topics) • Patients should be aware of clinic policies • Adherence to policies may also minimize liability concerns
3. E-communications with patients should occur through a method that is patient-centered and secure such as patient-portals	• Respond to e-mail correspondence with a request that the patient sign up for the portal and include a brief rationale for why portals enhance e-communication	• Portals are preferred over e-mail due to enhanced security, documentation, and workflow capabilities and for HIPAA (Health Insurance Portability and Accountability Act) compliance
4. All electronic communications should be documented in the medical record	• E-communication should be uploaded into the EHR	• Ensure accurate documentation of medical care provided via e-communication • Complete records enhance care
5. Clinical and ethical standards for relationships should be applied to electronic communication contexts	• Do not disclose personal elements in professional communication • Consistently apply clinical standards and ethical principles for maintaining the relationship, trust in the profession, confidentiality, privacy, and respect for persons to online settings and communications • Use clinical judgment in what is discussed via e-communication, for example, do not discuss sensitive test results (i.e., HIV results) or break bad news	• Keep professional and social spheres separate • Professionalism applies in all settings
6. Electronic communication between patients and their physicians, if done with attention to ethical and other concerns, may help improve patient care, patient satisfaction, and clinical outcomes	• Use e-communication (i.e., reminders, etc.)to manage chronic conditions (i.e., hypertension, diabetes, etc.) between in-person visits	• Some preliminary studies suggest that patient-portals may be a promising tool to help patients with disease management
7. Physicians and institutions should use electronic communication to promote health equity and proactively address the socioeconomic and demographic factors that may lead to disparities in uptake and utilization	• Promote health equity by encouraging patients to engage in portal use across all age, race and ethnic groups, with focused efforts on patient populations with low uptake and utilization rates • Use mobile devices to reach underserved patient populations for portal enrollment to reduce disparities	• Portal enrollment and use are lower among lower socioeconomic, older, and rural patients • Black and Hispanic patients may be more likely to access portals on their mobile devices than non-Hispanic white users; mobile technology can be used to improve portal access
8. Health care institutions should have policies on electronic communication methods. Medical schools, training programs, and institutions should educate trainees, physicians, and clinical team members and physicians about principles of electronic patient-physician communications	• Train and educate physicians, trainees and all involved in patient care on appropriate and effective use of e-communication, including integration into clinical workflows	• Clinicians and trainees should be taught evidence-based skills and behaviors for and ethics of e-communication • Training on e-communication skills with opportunities for feedback and continuous practice improvement can improve patient care in the digital age
9. Physicians, institutions and patients should recognize and address increased workload associated with management of electronic communication and implications for physician well-being	• Align patient and physician expectations for e-communication • Implement team-based care approaches to manage increasing demands of e-communication and EHR workload • Consider workflow protocols that appropriately delegate tasks and best utilize the team (i.e., message triaging by nurses based on standardized policies)	• E-communication may significantly increase the volume of physician work • Patient and physician expectations about using e-communication methods may not align and should be explicitly discussed • Physician well-being concerns and burnout have been linked to burdens associated with EHR work