Wednesday, April 2, 2008

High Stakes Email

High stakes emails (patient communication, reports, test results, prescriptions) need to be managed differently. Technology advancements in electronic communication can improve patient flow and health care wait times but it comes at a cost both in money and complexity. Our office has been communicating with referring offices, staff and patients for about 5 years now. Since my blog is about how clinics can manage efficiency I wanted to share our experience with email.

First, there is a big difference between the jokes I send my friends and communications about patients. I call the latter high-stakes email. High-stakes email includes receiving and sending referral letters, x-rays, communication to referring practitioners and patients, test results and e-Prescriptions. The technology involved can either hurt or help practice management so it needs to be well thought out. Here’s our experience.

Plan on errors: There is a big difference between being a single practitioner on a scooter with an i-phone, no staff and 500 patients and a larger clinic. The more patients you’re dealing with and the more people (staff and doctors) that are handling the emails the greater the chance of error. In short, if there is a way to mess it up it’ll happen. I have seen emails sent to every imaginable misspelled address, drag & dropped emails into never-never land, accidental deletions and much much more. The system needs to be designed to prevent errors.

Size matters: Not only will you have a greater number and variety of errors but you’ll be the target of attack. Size breads complexity so as you’re clinic grows the way you manage emails will need to change. Public accounts (gmail, yahoo, hotmail, etc…) cannot be used due to privacy and the chance of error. Spammers will also flood you're system so be prepared.

The effect of SPAM: Any network will be the target of attack. SPAM now makes up 80% of the worlds email (see Symantec reports). You’re system needs to be able to reliably sort the incoming email from the SPAM. Our office first scans for viruses then as SPAM. If a file has a possible virus it is automatically put into the SPAM folder. This double layered approach can create problems, because if a file is sent with an attachment that triggers either the virus or spam filters it will be quarantined. The staff dealing with communication needs access to the quarantined folders to find wrongly filtered emails.

Automate: Whenever possible we’ve automated drag/drops, moving of files and responses because on a large scale errors happen. For instance, when a patient is referred to the practice it is automatically imported into the referring managing software with attachments. When the new referral is checked by a staff member and data entered into the proper fields (name, phone number, etc…) an email is sent back to the source with the details of when and who processed the referral. As I’ve said in previous posts, the greater the number of steps the greater the chance of error. With automation, the chance of error is greatly decreased. Part of that automation is to add an automatic privacy statement to the bottom of each email.

Maintain Control: Whether you choose to have servers on or off-site maintain control. The real benefit of using e-communication is the integration it has with other programs. If you’re using a third party system, it’s more difficult to have automated actions (such as importing files directly) which decrease the error rates. Also, for control of spam and viruses you’ll need access to the quarantine areas of the system.

Request Read Responses: For medico-legal reasons you need to know if and when emails are read. Request the read response and have a system to track who hasn’t responded.

Tightly Control Email Addresses: Misspelled addresses are the norm. Create as many misspellings as you can and point the misspelled addresses to the proper addresses.

Get Help: Between misspelled addresses, 80% spam, viruses, dropped/lost/forgotten files, the desire to automate and everything else that happens with a small email network you’re going to need help. Find someone that has a broad knowledge base in database management, network and email management and pay them well. I found it cost more when we were cheap with out IT consultant.

Those are the major pitfalls that have befallen us over the last five years. We try to keep our error rate to 3.4 per million (6 sigma) but it’s a never ending battle. I hope sharing our missteps will help someone else that’s starting to use email.

1 comment:

Anonymous said...

Email is the best way for me to have an ongoing discussion about a case. I'm not stuck on the phone trying to get as much info out to the other party in as short a time as possible. I can even continue the discussion from home. It's an excellent tool for patient management.

Thanks for the tips.