As our IT administrator installs the latest in a long line of anti-SPAM filters (and if you're a SPAM spider here's my gift to you; firstname.lastname@example.org) I've had time to reflect on what email has meant to our practice.
When we first installed an MS-Exchange server in 2002 I thought it would be a rich-new tool to communicate with colleagues, improve staff communication and generally improve our business. I could not get along today without an in-house Exchange server (or a BES server for that matter) but it has not been without it's pit-falls. So here they are for all the world to enjoy:
One the up-side;
We have integrated email tightly with our EMR to generate auto-emails, create data-links for referring practices and quickly move incoming data to the proper EMR chart. It makes staff communication a lot easier and lowers the odds of lost communications. Gone are the days of someone trying to track me down to leave a message - now it comes through to my Blackberry.
RE: communication with patients;
Once you start a communication you loose control. For 99% of people this does not matter because requests are reasonable and questions genuine. For 1% you remain at their mercy with unreasonable requests for information, diagnosis you couldn't possibly provide over email (my best email was from someone I'd never seen before complete with pictures and 3 page history of the illness looking for a diagnosis). Also, once you acknowledge receipt of an email you are duty bound to follow-through until the issue is resolved. When someone visits the clinic much of the duty remains squarely in their lap.
It's a sad fact but as soon as you put something in writing there is the fear that it may end up being read one day in the courts. For that reason, colleagues shy away from speculation and opinion. For idle gossip this is inconsequential but when trying to solve a tough case and work to a diagnosis the result is you only get 1/2 of their thoughts.
SPAM and useless emails;
90% of the email that goes through our server is SPAM, 8% is FYI emails/pictures to friends or otherwise useless emails and 2% is necessary. A lot of hardware and work goes into maintaining a system that is 98% used for something other than the business for which it was bought.
I also thought when I called a company and they'd told me they lost an email it was just an excuse. Now they have my sympathy. There are thirty ways to loose an email; loose them in SPAM, drop them in some random folder, forget them at the bottom of the inbox, accidentally hit delete, attach them to the wrong patient chart, etc....
Email communication with referring offices and patients is fantastic but on a large scale it is not without it's problems. Think long and hard about when and how you will manage emails the carefully monitor the systems because if it can be broken it will.