Wouldn’t emailing letters to patients be better than posting them?

I have pretty much the same thought every week, just at the point when I have dictated another patient letter (using, needless to say, voice recognition software), and saved it to the file from which my lovely secretary will open it, add addressees and demographic data, print it, put it in an envelope and post it.  And the recurring thought is:  wouldn’t it be a lot quicker, easier, cheaper and better if we just emailed it instead?
I spoke to the Information Governance Manager at our Hospital Trust about this.  Don’t worry, first I had to find out that he existed before I could speak to him.  But he was helpful, and one of the things he told me is that emailing letters to patients is perfectly ok. This surprised me, but it is true: in some circumstances it is even actively encouraged.  He sent me a copy of the Information Governance review, chaired by Dame Fiona Caldicott and published in March, 2013.  It’s available here.

On page 28 of the report, in chapter 2, which is entitled ‘People’s right to access information about themselves’, there is a case study which I have reproduced below.



This may be an unusual example, but that’s not really the point.  The point (for me) is that people who have been tasked with advising about Information Governance are ok with people being emailed.

The Review Panel concludes that “personal confidential data can be shared with individuals via email when the individual has explicitly consented and they have been informed of any potential risk.” (p.28).
Well, that was news to me.  But as it turns out, our NHS Trust is in the process of developing a consent form, in which the conditions for use of email for communication between doctors and patients are laid out.  The agreement to use email is entered into at the request of the patient; possible security risks are understood; and the patient must email the Trust first to ensure that the correct email address is used.  It seems reasonable to me.
This is great.  I can email letters to my patients- if they want me to.  I would certainly prefer to, but I’m not sure how many patients would want that.  Some would, I’m sure, but we are a long way from having systems in place that could make this routine practice, in our department, anyway.  There is not (yet) enough digital healthcare in the NHS to create an expectation amongst patients that we would email rather than use paper mail.  Patients ask me to email them only very occasionally.  The ones who are noticeably well-organized about their healthcare (often because they have a very complex condition) often arrive in clinic with A4 ring binders containing large chunks of their medical records.  They still want paper to add to their files and email isn’t for them, at the moment (but see below). 
There are security concerns about email but it’s worth noting that the Information Governance review did not find much evidence that this was a problem in practice.  There’s no shortage of serious data losses, it is true, but these do not occur in the context of a data sharing agreement between patient and hospital .  They are more of the ‘laptop left on train’ type.  Chapter four of the report contains further details.
Widespread non-use of email is frustrating, though.  I dictate the majority of my letters within 24 hours of seeing the patient.  The text and layout of the letter are complete, but often the letter doesn’t go out for a couple of weeks or so after that, sometimes longer, because the members of our long-suffering secretarial team are over-stretched and have a constant back-log of work to deal with.
Paper mail is just so clunky and cumbersome.  How much money is spent in the NHS on paper, printers, printer ink (one of the most expensive commodities in the world?), envelopes, and franking machines every year, I wonder?  How much time is spent by secretaries, printing these bits of paper out, folding them, putting them into envelopes and standing at photocopiers making copies for the patient’s file?  How many people does the NHS employ to lug all these sackfuls of paper around?
There’s another bit in the Information Governance report which I found interesting: 

“Recommendation 1
People must have the fullest possible access to all the electronic care records about them, across the whole health and social care system, without charge.  An audit trail that details anyone and everyone who has accessed a patient’s record should be made available in a suitable form to patients via their personal health and social care records. The Department of Health and NHS Commissioning Board should drive a clear plan for implementation to ensure this happens as soon as possible.” (p.32).

We won’t even need to email patients if that vision is realised- they’ll be able just to log on and look the letter up.  Now that would be progress.

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