Editorial
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Recently, my personal
computer at the Journal office was linked to the
Internet, and thus, belatedly, electronic mail (email) became part
of my life. Great were my expectations -- no more lonely and
frustrating journeys through voicemail systems with their network
of black holes, no more interminable periods of being suspended, "on
hold", on the telephone or being bounced along the speaknet from
receptionist to personal assistant to doctors.1 Even better, the
telephone messages left on my desk, only to be lost amidst piles of
wanted and unwanted paper, were to be a thing of the past! Email was to be
my salvation -- my escape from the tyranny of the telephone. Despite my
initial euphoria, the jury is still out!
In the United States the use of email has increased dramatically from 100 000 users in the late 1970s to about 50 million in 1997, and it is predicted that there will be over 100 million users by 2000.2 In Australia, over 1.5 million people have access to email, and the number of subscribers is increasing at a phenomenal rate. These subscribers include about 500 000 home users, but educational institutions are the main users.3 This unprecedented expansion and the uptake of electronic communication have revolutionised effective and efficient communication, but there is also a downside. The release of my personal email address into cyberspace has meant that e-"junk"-mail and e-"chain"-mail can now be added to the irritating influx of irrelevant letters, facsimiles and brochures I already receive. It has also made me feel a loss of privacy. My office is now nakedly exposed to the world and I live in fear of 24-hour-a-day bombardment with irrelevant and inappropriate email. Thus, I have had to confront my first email crisis -- how will I manage this unwanted avalanche? The answer came from an illuminating speaker at a recent local communication conference who, when asked how he managed the large volume of email he received, explained that he does not read emails from people he does not know, as, if a message is important enough, the sender will usually phone him (Dr Karl Sveiby, Visiting Research Fellow, Queensland University of Technology, personal communication). What an elegant solution! In essence a hybrid between a telephone conversation and a conventional letter,2 email has its own language and defined protocols. Telephone conversations are valued for their spontaneity, flexibility and the important nuances of voice inflexions; letters have a long-standing tradition of etiquette, format, punctuation, capitalisation and observance of the rules of syntax. Email offers more permanence than telephone conversations, but its expression is often more spontaneous than that of letters. Thus, emails may be dispatched without editing, punctuation or capitalisation (the ee cummings email), or with no identification or contact details beyond those of the email address (the orphan email). The language of email is developing its own peculiar acronyms and abbreviations and, as its use proliferates, this "espeak" may eventually threaten the current vernacular. An email esperanto may yet evolve! However, despite my personal reservations, there is no doubt that email can and will revolutionise communications between physicians and their patients.4 Not only will email augment patient-doctor communication, it also has the potential to facilitate communications between the consumer, the medical practitioner and other healthcare providers.
An overriding concern in the use of email in healthcare involves issues of security and confidentiality of medical information, protocols governing doctor-patient communication and potential medicolegal issues. The American Medical Information Association has recently published guidelines for email communication and for administrative and medicolegal aspects of the use of email.2 The communication guidelines include not using email for urgent matters, informing patients about who actually processes messages, establishing the types of transactions permitted over email, and instructing patients to put the type of transaction in the subject line of the message for filtering. The administrative and medicolegal guidelines include instructing patients on when and how to escalate to phone calls and hospital visits; not forwarding patient-identifiable information to a third party without the patient's express permission; double-checking all "To" fields prior to sending messages; using email encryption whenever practicable, but waiving this at the patient's request; and backing up email onto long term storage media at least weekly. Similar issues are touched upon by Carter in this issue of the Journal,5 but, to date, there are no comparable published Australian guidelines for the use of email in healthcare. With the progressive invasion of our lives by the Internet, surely the time has come for explicit local guidelines.
Martin B Van Der Weyden | |||||
©MJA 1998 | |||||
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