The following is a round-up of some emails to the Editor reacting to the post entitled Abolish the Waiting Room that ran March 15.

Email

There were a few replies from physicians regarding the use of email and the concern about the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the transmittal of Protected Health Information (PHI). Bob Gellman, a Washington lawyer and privacy consultant, provides an interesting analysis of the new privacy requirements as well as clarifications of HIPAA law under the recently passed stimulus. To be sure there are applicable HIPAA-related issues once physicians open the electronic doorway to communications. There are ways around the issue, however, and vendors to help ease the way.

One solution is working with a HIPAA-compliant email vendors such as LuxSci or Sendmail that provide adequate encryption and backup technology that satisfies the transmission security requirements of HIPAA. For smaller healthcare practices, a HIPAA-compliant email provider is a preferrable because as the needs of the office grow and practitioners migrate to electronic medical records(eMR), other requirements of HIPAA come in to play. For instance, patient consent and disclosure accounting systems is a likely step for larger practices and hospitals systems. These systems provide an electronic tracking system for managing patient consent with regarding to sharing and disclosing ePHI and will be a critical piece of step on the road to adopting eMR by covered entities.

Twitter

There were a couple of interesting responses to using Twitter as a waiting room management tool. One GI specialist from Texas was representative of the skeptics. He wrote

Waiting room times might be applicable, however it would likely only apply to a small percentage of my patients. Also, you would have to be a follower to receive the tweets. It's not feasible to have one of my staff constantly monitoring how "on time" I am with my schedule. Schedules are quite dynamic and change frequently throughout the day. I might be 60 minutes behind and have a "no show" and two very brief appointments and be back "on time" in a manner of 15 minutes.

While Twitter may not be applicable to all practices, doctors that practice in urban, computer-savvy neighborhoods should consider adopting it as a tool. Staff can be trained to update the status every few hours and while it may not be appropriate to update it for every delay that the doctor has in a day, delays of longer than an hour as a benchmark, may be appropriate. Or a doctor comfortable using a Blackberry can update their status on their own. It would also be a great way to let patients know you are on vacation that week or when cancelling all appointments scheduled due to emergency surgery, etc. Patients do not have to become a "follower" of a particular doctor to see a doctor's tweets. They can view that doctor's tweets by entering the URL directly (such as going to http://www.twitter.com/healthspacesrx). Discretionary judgement is the key. A geriatric practitioner may not have much use for Twitter as an orthopedist who deals with high school or college age athletes (and are more likely to have Twitter accounts).

Summary

Understanding your patients and how they communicate is a first step in determining the appropriate communication tool set. Perhaps like other businesses, it's a good idea to ask your patients how they would like to hear from you and which forms of communication they prefer. It's an important input into whether or not enough of your patients would be interested in the particular communication medium to make it worth the investment. While compliance measures are a critical piece of the implementation process, the patient's preference is an important decision lever when deciding which tools work best for you.