We expect the highest quality of care, including face-to-face interaction between the patient and provider whenever possible. To reduce liability and the risk of medical errors made possible by electronic mail consultations, EmblemHealth has adopted the following guidelines set forth by the American Medical Association:
- Establish turnaround time for messages. Exercise caution when using e-mail for urgent matters.
- Inform patient about privacy issues.
- Patients should know who, besides addressee, processes messages during addressee's usual business hours and during addressee's vacation or illness.
- Whenever possible and appropriate, retain electronic and/or paper copies of e-mails communications with patients.
- Establish types of transactions (prescription refill, appointment scheduling, etc.) and sensitivity of subject matter (HIV, mental health, etc.) permitted over e-mail.
- Instruct patients to put the category of transaction in the subject line of the message for filtering: prescription, appointment, medical advice, billing question.
- Request that patients put their name and patient identification number in the body of the message.
- Configure automatic reply to acknowledge receipt of messages.
- Send a new message to inform patient of completion of request.
- Request that patients use auto-reply feature to acknowledge reading clinician's message.
- Develop archival and retrieval mechanisms.
- Maintain a mailing list of patients, but do not send group mailings where recipients are visible to each other. Use blind copy feature in software.
- Avoid anger, sarcasm, harsh criticism and libelous references to third parties in messages.
- Append a standard block of text to the end of e-mail messages to patients which contains the physician's full name, contact information, and reminders about security and the importance of alternative forms of communication for emergencies.
- Explain to patients that their messages should be concise.
- When e-mail messages become too lengthy or the correspondence is prolonged, notify patients to come in to discuss or call them.
- Remind patients when they do not adhere to the guidelines.
- For patients who repeatedly do not adhere to the guidelines, it is acceptable to terminate the e-mail relationship.
Legal and Administrative Guidelines:
Develop a patient-clinician agreement for the informed consent for the use of e-mail. This should be discussed with and signed by the patient and documented in the medical record. Provide patients with a copy of the agreement. Agreement should contain the following:
- Communication guidelines (stated above).
- Instructions for when and how to convert to phone calls and office visits.
- Clauses which hold harmless the health care institution for information loss due to technical failures.
- Waivers of the encryption requirement, if any, at patient's insistence.
- Descriptions of security mechanisms in place, including:
- Using a password-protected screen saver for all desktop workstations in the office, hospital and at home.
- Never forwarding patient-identifiable information to a third party without the patient's express permission (in writing).
- Never using patient's e-mail address in a marketing scheme.
- Not sharing professional e-mail accounts with family members.
- Not using unencrypted wireless communications with patient-identifiable information.
- Double-checking all "To" fields prior to sending messages.
- Performing at least weekly backups of e-mail onto long-term storage. Define long-term as the term applicable to paper records.
- Commit policy decisions to writing and electronic form.
The policies and procedures for e-mail should be conveyed to all patients who wish to communicate electronically.
The policies and procedures for e-mail should be applied to facsimile communications, where appropriate.
Glossary terms found on this page:
An activity of EmblemHealth or its subcontractor that results in:
- Denial or limited authorization of a service authorization request, including the type or level of service
- Reduction, suspension or termination of a previously authorized service
- Denial, in whole or in part, of payment for a service
- Failure to provide services in a timely manner
- Failure of EmblemHealth to act within the time frames for resolution and notification of determinations regarding complaints, action appeals and complaint appeals
Services rendered by a physician whose opinion or advice is requested by another physician for further evaluation or management of the patient.
An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:
- Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
- Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
- Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
- Maintains medical records for all patients
- Has a requirement that every patient be under the care of a member of the medical staff
- Provides 24-hour patient services
- Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements
A unique number that identifies the member's enrollment with EmblemHealth. EmblemHealth's claims are processed by this number. Also known as Member ID Number.
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.
An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.
Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.
A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.
A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.
A written order or refill notice issued by a licensed medical professional for drugs available only through a pharmacy.
A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:
- Doctor of medicine
- Doctor of osteopathy
- Doctor of podiatric medicine
- Physical therapist
- Nurse midwife
- Certified and registered psychologist
- Certified and qualified social worker
- Nurse anesthetist
- Speech-language pathologist
- Clinical laboratory
- Screening center
- General hospital
- Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes
A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.