Secure messaging: Much more than e-mail

These new systems allow physicians and patients to communicate online without confidentiality concerns. They can also help you manage Web-based transactions with patients.

Boston internist Richard A. Parker used to exchange e-mail with patients. Now he's joined a small but growing number of doctors who are able to send patients secure online messages, thanks to sophisticated technologies that are relatively new to health care.

The Web-based messaging system Parker uses, called PatientSite, was custom-designed for his integrated delivery network, Care Group, by its chief information officer, John D. Halamka. It's one of a handful of home-grown systems; most physicians with secure messaging obtained it from commercial vendors.

PatientSite allows patients to inspect their online medical records, check lab results, schedule appointments, request prescription refills and referrals, check the status of their bills, and exchange messages with the doctor. But unlike regular e-mail messages, which can be intercepted or changed as they move from the patient's Internet service provider to the physician's ISP, messages sent via PatientSite are virtually guaranteed to remain confidential. That's the point of a secure system: It alleviates physician worries about liability risks resulting from security breaches. The messages patients write on PatientSite are encrypted before going directly to the server, where physicians retrieve them in decrypted form.

Halamka, an emergency physician, designed the system using an audit trail to augment the encryption. "Our audit captures almost every keystroke," he says. Patients can review the audit trail to make sure no one has unauthorized access to any of their medical information—including online messages between them and their doctors.

Partly because of security concerns, e-mail communication between doctors and patients has grown very slowly across the country. According to a study by Medem, a network founded by the AMA and medical specialty societies, only 10 percent of physicians use e-mail daily or weekly to communicate with patients—even though 70 percent have Internet access in their offices.

Family physician Ronald P. Bangasser, medical director of Beaver Medical Group in Redlands, CA, says physicians in his group have shied away from e-mail because of worries over confidentiality. But most patients don't share those concerns, he says. Some have already sent e-mail to their doctors. To satisfy them, Beaver is evaluating vendors who provide secure online communications to patients and other physicians.

Bangasser says he's been approached by dozens of vendors, but he remains skeptical. "We're being careful, because it's really important to do this right," he says. "This is new territory."

Security isn't the only advantage these new messaging systems have over regular e-mail. Many of them come with features designed to improve office workflow. For example, some sort online patient requests for appointments, prescription refills, and referrals and route them to the appropriate staff member, rather than to the physician, so the doctor doesn't have to read and re-route administrative requests.

Physicians who use secure messaging systems say they're just as effective as e-mail in reducing the amount of time that they and staff members must spend on the phone with patients. Charleston, SC, psychiatrist John F. Abess has subscribed to a free Web-based messaging service for more than a year and says he's seen definite improvements in practice efficiency. Although he receives only a few patient messages a day, each is "one less telephone interruption," giving Abess and his assistants better control of their time. Parker says he typically receives four or five messages from patients each day. Responding by computer takes far less time than returning phone calls, he says, so he can usually end his day a little earlier.