Q What precautions should be taken when communicating with patients via email?
A Email is being used in various ways as an additional method of communication between GPs and their patients. Examples include:
- Prescription requests
- On-line consultations.
Practices that have a reliable email system which is actively managed, and where emails are checked regularly, may find that the use of emails leads to a reduction in the number of some appointments, telephone calls, and letters received from or sent to patients.
Some practices have a website from which patients can complete an electronic request for prescribed medication. To enable this, most practices give full information to patients about the benefits and the risks of this type of request, and also supply a password to make the site and the request more secure.
However, the internet is not secure; password protection may exclude most people, but others may see this as a challenge. Providing a patient with a password should ensure that the practice is able to get the full, informed consent of the patient.
On-line consultations have been in the news and computer press over the past 12 months. On-line consultation is defined as an episode where a patient and clinician are electronically linked in real time.
Limitations of the system include the ability to send only text messages, typed on a keyboard by one party and viewed on screen by the other. It is very difficult to capture the breadth and meaning of the spoken work in a few lines of text. The speed of communication is much slower than a telephone or face-to-face consultation.
The BMA's view is: 'Time-delayed email exchanges are not safe enough for consultations. Providing authentication, security, integrity and non-repudiation are satisfied, they can be useful for low-level non-clinical communication with patients.'
For further information, look at Consulting in the Modern World – Guidance for GPs produced by the General Practitioners Committee of the BMA (http://web.bma.org.uk/gpc.nsf/guidancevw – then general guidance).
Q Is it safe to send referral letters by email to the local hospital?
A The simple answer is no. Even with the use of NHSnet, emails are not considered secure unless they are encrypted.
Under The NHS Plan, referral letters, outpatient letters and discharge summaries will routinely be sent electronically by 2004.
To achieve this the IT infrastructure needs to be in place. The target date for achieving this in general practice is March 2002, and in hospitals is March 2003.
In addition, the NHS is developing and will institute a security policy which will ensure that all messages sent over NHSnet or the internet that have patient identifiable data will be encrypted.
My advice is to wait for the time being; this is the way forward, and all parties are committed to delivering this as soon as possible.
Q Can a primary care group or trust insist that a practice moves to a different GP computer supplier to achieve consistency throughout the organisation?
A The regulations have not changed: health authorities and the new primary care organisations are prohibited from doing this by specific regulations.
The computer budget for general practice is held within the General Medical Services (Cash Limited) budget. This funding is specifically for reimbursement of general practice. The PCG or PCT can only alter the use of this fund after consultation with the LMC.
If a practice feels that it is being forced to change computer suppliers against their wishes, then I would suggest they discuss the matter with their LMC.
Some may argue that having a common system would be an advantage; for example, equity of provision would be easier to assess, common training programmes could be arranged, and a common approach to disease coding could be supported.
Against this, it could be argued that all systems have their strengths and weaknesses – there is no perfect system. Also, it is expensive to change systems: often a minimum of £10 000 is required to convert data alone, and even then full data conversion is not guaranteed.
Over the past 2–3 years the number of GP computer suppliers has decreased; it would be an expensive mistake to change systems only to find they were taken over and further conversion was required.
Common coding and data entry can be achieved over a number of clinical systems.
Finally, data transfer is an issue that will be solved shortly when true GP-to-GP transfer of electronic patient records are achieved. All the different clinical systems will have to be able to communicate with each other then or they will cease to be used.