Editor Charles Jaffe, MD, PhD Director of Medical Informatics AstraZeneca, 1800 Concord Pike, FOC CE 1 Central East 1-316, Wilmington, DE 19850, USA. E-mail: [email protected]

Secure Physician-Patient Messaging Computer-based messaging is replacing the telephone for many physicians. Conventional e-mail with patients is unsatisfactory for numerous reasons. Highly sophisticated, secure, HIPAA-compliant technologies have been developed to supersede e-mail. Some third-party payers have begun to reimburse providers for these activities. These web resources provide information about various communication technologies as well as opportunities for use in practice. This list is not exhaustive nor is it meant as an endorsement of any sites or products, but rather as an opportunity to learn about some of the available resources.

ClinicalMessenger (Kryptiq) http://www.kryptiq.com/Products/ClinicalMessenger.html Unlike some resources, Clinical Messenger is not a stand-alone product. Instead, it integrates with existing electronic medical record systems to provide messaging from within the record. The principal capability of this technology enables the transfer of health records and chart documents between electronic medical record (EMR) systems, even across selected vendor platforms. Secure e-mail can be directly included in the health record. Site last updated: Frequently. Access requirements: By license.

Relay Health http://www.relayhealth.com/ This messaging system relies on a user-friendly webpage interface to allow physicians and patients to communicate through a secure socket-layer website. When patients visit their personal pages, they are presented various options, including making an appointment, requesting a prescription, reviewing a payment, or communicating with the professional staff. By this means, the message is automatically triaged to the specified individual in the physician’s office, with appropriate role-based privileges. Prescriptions may be automatically forwarded to a specified pharmacy, and physicians and nurses may respond to specific inquiries. Site last updated: May 2004. Access requirements: Multi-level, use-based fees.

MyDocOnline Connect https://www.mydoconline.com/Marketing/providers/connect.html Once owned by Aventis Pharmaceuticals, MyDocOnline was acquired by ZixCorp in February 2004, to expand its secure messaging technology into the field of health care. A suite of tools provides the clinician or practice with a menu of capabilities for communicating with patients, laboratories, and other providers. Within this framework, patients can request appointments, prescription refills, referrals, and clinical information. There is also a feature that permits an online physician visit, now individually designed to meet the needs of specific specialties. Site last updated: Frequently. Access requirements: Multi-level, use-based fees.

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eMediary (Caveo Technologies) http://www.caveotechnology.com/html/eMediary_Providers.htm The Caveo technology permits the physician or patient user to access communications through a secure website. To enhance compliance, all users are notified of the receipt of information through traditional e-mail applications. Thereafter, communication is processed through the system portal for viewing and response. In addition, the system facilitates the transfer of documents or data through a file-transfer technology. The system also allows automatic reminders, refill notification, and adherence messaging. Currently, the technology is available only to health care systems. Site last updated: June 2004. Access requirements: By license.

Secure Messaging (Medem) https://www.yourpracticeonline.com/ Secure Messaging is part of a more comprehensive practice website developed by Medem, a consortium of professional medical societies. In addition, the Online Consultation capability provides an effective, secure, HIPAA-compliant resource for nonemergency communications. Moreover, the system offers the ability to document the electronic encounter and bill third parties when the payer system permits. The site provides structured templates that are used to enable members of the office and professional staff to identify specific requests and communication within the varied functions of the medical office, including scheduling, billing, and prescription requests. In addition to professional societies, various state and local medical societies have leveraged this technology for their individual members and tailored the interface to their specialized requirements. Site last updated: Unknown. Access requirements: Available to physicians with membership in the component societies.

Siemens Medical Solutions http://www.medical.siemens.com/webapp/wcs/stores/servlet/PressReleaseView? langId=-1&storeId=10001&catalogId=-1&catTree=100005,13839&pageId=22386 Using a technology that was developed by Sigaba (http://www.sigaba.com), a company specializing in secure messaging, Siemens has developed an enterprise-wide solution for physician–patient communication. Even a form of instant messaging is protected and secure within the framework of this system. Currently, this technology is only available within clinical health care networks. Site last updated: Unknown. Access requirements: By license.

Guidelines for Physician–Patient E-Mail American Medical Informatics Association http://www.amia.org/pubs/other/email_guidelines.html Although there has been no formal legislation to codify or regulate e-mail between providers and patients, several organizations have provided guidelines by which communications should be conducted. In the landmark publication that first appeared in the Journal of the American Medical Informatics Association (AMIA) in 1998, Kane and Sands provided a perspective that is often quoted and frequently used. Site last updated: January 7, 2003. Access requirements: None.

American Medical Association http://www.ama-assn.org/ama/pub/category/2386.html The American Medical Association (AMA) published their updated guidelines that address the evolving landscape, as well as technical innovation. In addition to formal recommendations, the AMA site also addresses legal and ethical issues. Site last updated: May 16, 2003. Access requirements: None.