Establishing Pharmaceutical Care Services
Using Electronic Communication
Embarking on services involving e-mail communication with patients or with other providers requires a thorough understanding of the appropriate use of e-mail in health care. While providers who are separately responsible for providing care to a specific patient can consult and share personal health information of the patient, doing so electronically makes secure and appropriate use of e-mail more important. Precautions to consider in establishing pharmaceutical care services that use e-mail for communication include:
1. E-mail cannot be used in the case of urgent or time-sensitive communication. Patients who e-mail a pharmacist for advice must know that the pharmacist may not read the message soon enough to give timely advice when immediate attention is needed. Patients must be instructed beforehand on when they should escalate to phone calls to the pharmacist, phone calls to their physicians, visits to their physicians, or calling 911.
2. E-mail messages containing PHI of patients require password protection for computers, encryption, and authentication in transmission of patient information. Typical e-mail services are not adequate for protection of PHI.
3. E-mail consults with patients should occur in the context of therapeutic relationships that have been established with in-person contact.
4. E-mail communication with patients or providers becomes part of a patient’s permanent medical record and, in pharmacy practice, patient medication profile.
5. Patients should provide written informed consent to use of e-mail in pharmacist– patient communication. Issues of system security and appropriate versus inappropriate uses of e-mail can then be conveyed and patient understanding verified.
6. Never forward patient-identifiable information or e-mail addresses to a third party, even a family member, without a patient’s written permission.
The American Medical Association (AMA) has developed guidelines for
patient consent forms to be used by physicians establishing e-mail services in patient care.
Pharmacists who wish to begin using e-mail as part of their patient care services should examine these guidelines carefully
Information in the consent form should include:
1. A consent statement that expresses the patient’s desire to use e-mail communication.
An example statement might be “I wish to use e-mail or other Internet-based communications (online interaction) to facilitate my receipt of health care from (Name of Pharmacy).”
2. The circumstances under which e-mail should not be used (e.g., emergency or other time-critical situations). Statements such as “I understand that responses to e-mail requests will be made within (timeframe such as 24 hours). I understand and agree that I am not to use e-mail in emergency or other time-critical situations.” Examples of emergency situations specific to the patient’s condition should ideally be included. For a patient with angina, for example, consent forms may include instructions to call 911 if there is
• Severe or ongoing pain unresponsive to angina medications
• Pain lasting 20 minutes or more
• New pain at rest or with minimal activity
• Severe shortness of breath
• Loss of consciousness
• Just feeling the need for immediate help
Other examples of time critical situations include bleeding with anticoagulants, having a heart rate of less than 60 beats per minute with low blood pressure, or fainting for someone on a beta-blocker.
3. The types of e-mail requests or questions that are acceptable (e.g., refill
requests, requests for information on prescription or OTC medications being used, or requests for a review of medications being taken from various sources).
4. Who in your pharmacy (support staff) will have access to e-mail and who may handle specific types of e-mail inquiries or requests. For example, who will be authorized to respond to drug information questions, price quotes, product availability, or refill requests? Which inquiries will be handled only by the pharmacist, and which may be handled by either a pharmacist or a technician.
5. Fees that will be charged for specific online services.