Email communication with patients: privacy and patient safety

• Healthcare organisations can use email to communicate with patients – as long as they take reasonable steps to ensure patient privacy. 
• Always seek and document the patient’s consent before sending their personal information using email. 
• Implement clear practice policies to help avoid privacy and patient safety breaches. 

Many practices and doctors worry about whether they can send information by email or whether emails need to be encrypted.  

Privacy legislation does not prescribe how you or any healthcare organisation should send health information to patients or third parties. Any method of communication can be used as long as you take reasonable steps to protect the privacy of the patient and the security of their health information. So, yes, you can use email to communicate with your patients and third parties.  

The Office of the Australian Information Commissioner (‘OAIC’ – which includes Australia’s Privacy Commissioner) has outlined the steps it considers reasonable for organisations to take when communicating by email in its Guide to Securing Personal Information. In line with this guide, we recommend considering the following: 

Email encryption is ideal but not essential 

Using encryption is the safest way to send an email and you should use it wherever possible.  

However, the OAIC does not insist that healthcare organisations use encryption as a minimum standard in all cases. Rather, you need to “develop procedures to manage the transmission of personal information via email”, recognising that email is not necessarily a secure form of communication.  

You do need to consider the type of information you are sending and whether it is appropriate to send by unsecured email.  Depending on the sensitivity of the information you may need to take additional steps to protect it by attaching the information as a PDF document with a password. How you provide the appropriate password to the patient is another consideration, but options could include a separate email, an SMS or something elected by the patient and stored in your system. 

Have a clear policy 

Just because it is easy to send an email does not mean it is appropriate. For this reason, you need to develop practice policies about the appropriate use of email to communicate with patients. All staff need to be clear about what they can and cannot send by email, and the steps they need to take if they are using email. 

Even if your practice does not correspond by or encourage email, you may still receive email from patients, so it is important that your policies address how email communications will be managed.  For example, if patients send you clinical images by email ensure you have a mechanism for adding them to the patient’s records. For more information on this issue Avant factsheet – clinical images.  

Make sure you have patient consent 

You may need to send information by email, for example as part of a telehealth consultation, or in response to a patient request. In this case, if you are not using encrypted email, advise the patient about the risks associated with using unencrypted email and confirm they still wish to have the information sent in that way.  

Ideally, you would get patient consent in writing. If that is not practical, make sure you get the patient’s verbal consent and document it in their clinical record. 

However, if you have any concerns about sending specific information to a patient or to a third party at any time, confirm the details and patient consent before sending.  

Check the address before pressing send 

The OAIC consistently reports that personal information being emailed to the wrong recipient is the most common cause of human error privacy breaches.   

Another cause of error is auto-complete – where software programs default to recently or frequently used addresses.  

Other sources of error could involve misheard or mistyped email addresses, or accidentally using ‘reply all’. 

Patients may have more than one email address. They may not want information sent to a work or shared email for example, so make sure you check which address they want you to use. 

Useful tip to avoid email address errors 

To avoid email errors, you could ask the patient to email you requesting the information and giving consent to reply using email. This serves both as a record of the patient’s consent and confirmation of their preferred email address. 

Password protect sensitive information 

Your policy needs to address whether and how you will send particular types of information, for example results, prescriptions, or referrals.  

You do need to consider the type of information you are sending and whether it is appropriate to send by unsecured email. Depending on the sensitivity of the information you may need to take additional steps to protect it by attaching the information as a PDF document with a password. How you provide the appropriate password to the patient is another consideration, but options could include a separate email, an SMS or something elected by the patient and stored in your system. 

Use a privacy disclaimer 

It is useful to have a privacy disclaimer on all emails leaving the practice as an additional protection. 

As with any communication, your process needs to ensure incoming emails are passed onto the appropriate person and actioned. Ensure incoming and outgoing emails are saved in the patient’s clinical record and managed in accordance with record-keeping requirements.  

Take care when opening incoming emails including clicking on links and opening attachments.  

For more information please see Avant’s factsheet: Storing, retaining and disposing of medical records. 

Even if your patient consents to communication by email, there may be circumstances in which you are not comfortable emailing them information. The information may be particularly sensitive or detailed or need a complex explanation. It is always appropriate to exercise your clinical judgement to decline to send such information by email. You may consider a face-to-face or telehealth consultation is necessary.  

We would consider it inappropriate to deliver any bad news to a patient via electronic means. 

You may also find that a patient responds to an email with further questions. Try to avoid back-and-forth conversations over email.  There is a risk that these will turn into a chain of correspondence, and you may find yourself providing medical advice without a proper consultation. In these situations, it is appropriate to decline to respond further via email and ask the patient to make an appointment. 

Ensure email communication with your patient is only provided in accordance with your indemnity insurance policy, and ensure you comply with the Medical Board of Australia’s Guidelines – Telehealth consultations with patients, as there may be requirements such as having had a previous spoken consultation.  

If your practice website allows emails to be sent to the practice via the website email link, make sure an employee is responsible for monitoring any emails sent this way. You can use keywords to block certain emails.  For example, you could use a keyword filter such as ‘test’ that will result in the email being blocked and a message would be sent to the sender asking them to contact the practice to make an appointment.  

Time-sensitive information 

You can send time sensitive information by email, but you do need some safeguards in place to be sure the information has been received and actioned. You might ask the patient to acknowledge receipt of any email communication either by a generated ‘read receipt’ or a manual return email, depending on the sensitivity. Confirmation of the receipt of the information by the patient should also be saved to the file. Have processes in place to follow up the patient if the patient does not contact you in response to the email.  

Urgent after-hours emails 

Practices are not required to check email addresses 24 hours a day. However, you do need to be clear about how the account is being monitored, particularly if you publish the address anywhere, such as on your website. You could outline when email will be responded to and include an autoreply advising whether the address is being monitored and providing an appropriate emergency contact. 

Office of the Australian Information Commissioner - Guide to securing personal information 

 Royal Australian College of General Practitioners - Using email in general practice 

Avant - Email communication policy checklist

For medico-legal advice, please contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.