Online Patient-Clinician Messaging

Published by the United States' Veterans Health Administration (VHA)'s National Ethics Committee (NEC), this document examines ethical concerns that arise when patients and clinicians communicate online and offers recommendations for the ethical use of online messaging as a health care technology.

The publication is motivated by the conviction that "Widespread adoption of computer-supported communication between patients and clinicians, i.e., 'online' health communication, seems all but inevitable. Surveys repeatedly show that patients want to be able to email their clinicians to make appointments, refill prescriptions, get the results of clinical tests, even ask health-related questions that don't require an office visit...."

As the authors explain, despite its potential, online patient-provider communication raises a number of ethical questions about privacy and other concerns. Their aim in creating this resource is to help "assure that good communication practices are adopted so that patients' interests are protected and online communication takes place in a way that enhances, rather than imperils, patient-clinician relationships."

This report is intended for health practitioners worldwide seeking guidance on whether and how to integrate new information and communication technologies (ICTs) into their relationships with patients. VHA offers the following recommendations, as excerpted from the Executive Summary:

1. "Clinicians and health care organizations should ensure that online communication takes place only when the confidentiality and security of personal health information can be reasonably assured.
2. Clinicians should ensure that patients who do not interact electronically receive the same quality of care as their online peers.
3. Clinicians should be aware of the potential effects of online messaging on the patient-clinician relationship and take steps to avoid 'depersonalization.'
4. Participation in online messaging should be voluntary for both patients and clinicians.
5. Clinicians should assure that patient participation in online communication is well informed.
6. Clinicians should limit their online communication with patients to appropriate uses.
7. Health care organizations should recognize online interactions with patients as part of clinicians' professional activities in institutionally appropriate ways."

To illustrate how these guidelines have been integrated into a particular programme, the report shares the example of "HealtheVet", VHA's "web-based application that creates a new, online environment where veterans, family, and clinicians may come together to optimize veterans health care." The portal's development is described here, with a focus on the protective measures that organisers have put in place to foster communication processes that are conducive to patient participation and improved health-care outcomes - without compromising confidentiality.