Table 2.

General Tips for Patient-Physician Electronic Communication (Including E-mail and Portal Use)

Before initiation of e-communication	• Discuss risk, benefits, expectations and appropriate uses of e-communication • Discuss security, confidentiality and record keeping • Help ensure policies and procedures are clearly communicated with patients and practice shares a printed or electronic copy with patients • Clarify how urgent and emergent situations should be handled • If multiple electronic exchanges are needed or there is any confusion about the electronic message, an in-person or telephone consultation should be initiated • Patient consent to e-communicate should be documented in medical record if possible
Establish appropriate topics	• Prescription refill requests • Appointment requests • Short questions that can be answered briefly • Questions or updates about non-urgent clinical treatment matters (i.e., medication side effects, etc.) • Reporting health data for chronic disease management (i.e., blood pressure, blood sugars, etc.) • Inquiries about laboratory or study results
Establish inappropriate topics	• Clearly define urgent and emergent conditions that are not appropriate for e-communication (i.e., chest pain, shortness of breath, etc.) • Time-sensitive requests • Use clinical judgment in what is discussed • Set parameters for when to ask patient to come in for an office visit
Maintain professional standards	• Separate personal elements from professional communication • Avoid anger, sarcasm, jargon and disparaging comments as with any communication
Set expectations for responses	• Set clear expectations regarding turn-around time for responding to messages (i.e., between 2 and 3 business days) and whether messages are checked on weekends • Establish maximum turn-around times (e.g., 72 h) • Establish clear coverage plan for when physician is out of office • Establish that if patient does not receive response in timely fashion, patient should call clinic to discuss issue
Acknowledge receipt of message	• Acknowledge receipt of e-mail or portal messages and ask patients to acknowledge that they have read messages; this process may be automated through specific e-mail or portal functions
Security	• Patient information should not be shared over connections with inadequate security, which may include residential internet connections; use multifactor authentication to verify user identity when accessing portals or e-mail • Public unsecured wireless networks and cellular device networks are inherently publicly accessible and should not be used; access portals and e-mail through a work-based encrypted virtual private network when available to enhance security • Use a practice dedicated e-mail address that utilizes encryption software to secure messages
Clarify expectations for response	• Include a summary of when e-mail or portal messages will be answered and remind patients to seek immediate help for urgent matters • Set up automatic away message when on vacation or not checking portal messages or e-mail regularly with information on how to contact covering physician
E-mail specific communication tips*
Document e-mail communication in the EHR	• Relevant e-mail communication should be uploaded into the EHR to document the exchange
Encourage transition to patient-portal	• Respond to patient e-mail correspondence with a request for patient to sign up for the patient-portal and include a brief rationale for why portals enhance e-communication
Patient-portal Specific Communication Tips
Confidentiality	• Patients should know that messages will be included as part of their medical record and other members of care team (i.e., nurses, physician assistants, front desk staff) may read and assist in message triage
Other
Text messaging and social media	• Text messaging, multimedia messaging services (MMS) short message service (SMS), and social media applications should not be used for patient-physician communication about clinical matters

Acknowledgment: Some tips in this table were adapted from¹¹ Kane B, Sands DZ. Guidelines for the clinical use of electronic mail with patients. J Am Med Inform Assoc. 1998;5:104–11

*While we recommend patient-portals as the preferred method for e-communication for high-quality care, security, confidentiality, documentation, and workflow reasons, we recognize that physicians may continue to use e-mail to communicate with select patients