Electronic communications for patients

Why we need Electronic Communications

We live in a world of email and electronic communications, so why can't NHS staff email letters to patients and GPs and Consultants converse about shared patients using email?

Well, 'off the record' I hear that many of patients DO actually send and receive emails to and from their GPs  and private doctors, - presumably without any patient identifiable content, but this practice is not widespread and in Hospitals, it is rare.

It seems that Hospital communications requirements are somewhat different to those in General Practice since a plethora of electronic systems are in use, with numerous medical staff looking after each patient who constantly change teams, making e-communications more difficult. Furthermore there is nothing worse than sending a message or letter to a patient or GP when it concerns a different patient, so if NHS Information Governance prohibits the sending of any patient identifiers, this creates a problem from the very start because its so easy to send the wrong letter to the wrong patient.

After some local digging around we have discovered that there is actually a process to do this in our own hospital!  It is only if staff follow the local policy which, as you can read, makes it fairly hard work in terms of getting consent, managers permission and copying emails into case notes. This extra work probably puts off a lot of patients and staff so our local email policy is probably not often used. Certainly there is no record of patient email held on any centrally accessible system in any of the NHS Hospitals that our Consultants visit.

Some NHS services have developed this more than ours- for example the West Midlands Cervical Screening service gives staff and patients the option to use email encryption (see excellent summary of current rules on their Datasheet)- but we have no idea of the uptake, even in this presumably younger group of patients.

With rising postal costs and inefficiency of many hospital's paper based record systems, one might imagine the savings as well as improved patient satisfaction and health professionals time if e-communications became possible.

From the medical point of view using email also raises the possibilities of pointing patients to better resources or information either on your own website (eg Haste Academy) or other UK or outside UK sites- which can potentially harness the power of the internet.

In a recent 'straw poll' of 30 consecutive patients seen one week in a general NHS cardiology outpatient clinic (in Surrey) 28 of 32 patients said that they had an email address and 25 were happy for clinic letters and results to be sent using non encrypted email.

Some of the reasons why Emailling NHS patients has NOT yet happened

  1. Email servers are easy to hack and thus any non-encrypted email sent is effectively 'public'.
  2. NHS IT Governance and basic privacy laws prohibit sending open email that contains patient identifiers or medically confidential information- emailing a letter to a patient containing patient data to an email address outside the NHS mail network breaches this policy unless specific written consent has been obtained from the patient.
  3. Sending an email to a patient may encourage a reply and invite more questions- which in some cases can be very time consuming. Many health care workers thus fear that if more time is spent dealing with email enquiries less time will be available for  'hands on' medical care.
  4. For a Healthcare professional dealing with a patient's email, we requires access to their full medical case notes, which are often not available at the time.
  5. Emails about patients, both incoming and outbound comprise part of the medical care record, so must be printed and filed in the case notes, unless an electronic equivalent is available. This step can be time consuming and often not done, which means the contemporary record of medical care is disrupted and complicated to unravel.

Making a start: HasteNinGS- our solution

They say "necessity is the mother of invention", and as we start on a potentially large clinical screening service across Guildford and Waverley on a strict budget we are painfully aware of the extra costs (and thus the extra charitable donation required) to send out appointment letters and results by second class post- hence the drive to make our new service as paperless as possible. Our plan is therefore:

  1. Offer 'Connect' to all patients we are referred, right at the start. We will audit its take up.
  2. Make full use of this private messaging between staff and patients within the Haste Academy web site.  When activated (see instructions), every member can choose to receive private messages from other users, with or without email notification. If you are a patient and wish to use this service- register and mention it to your team so they too can register and private messages can then be exchanged.  Our service is free of charge, whether medical, admin staff or patients, and your data will never be 'mined' or shared with anyone outside our organisation, although bear in mind that the medical team may use the contents of their mailbox as part of your medical record and this information can also be release after a successful data sharing application in accordance with the Data protection Act.
  3. Although all Health Academy 'users' can be searched and found using our Membership search,  use a pseudonym or username that you share information with your health care team, patients' or colleagues which will minimise the chance of unsolicited email or spam.
  4. Healthcare professionals can send simple messages to patients but elect NOT to be able to receive messages back through this system, but instead via their office, so as not to get overloaded with emails.
  5. Where letters and results need to be sent instead of plain text messages, we plan to offer a one time encryption pad where a Passcode is agreed between the medical team and patient during a face to face consultation. For more information see Haste Academy Encryption: How

Under development

  • Incoming and outgoing email transcript contained the electronic record
  • Cloud based records- results and reports are stored (with patient consent) on a cloud server which can be accessed by anyone given permission by the patient.

Related stories and links

One time encryption pad
One time encryption pad: the science
Is an USB card the future?
Why Connect?
More direct access
Interactive referrals
 



Written by

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Edward Leatham is a Consultant Cardiologist in Surrey and a Trustee of Haste and Haste Academy.

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