Background
Clinicians face an increasing need to communicate with patients through digital technology, like email and text, to improve efficiency and convenience for both patient and care provider.
In response to requests from patients and clinicians for communication through email and text, the BC Centre for Disease Control (BCCDC) developed draft Email and Text Guidelines in collaboration with the Provincial STI Clinic and representatives from BCCDC Privacy and Patient Safety & Quality. A pilot email/text program was then implemented in the Provincial STI Clinic to test the initial version of the guidelines.
Process
Security concerns are often the primary barrier to communicating with patients through email and text, as these channels are not considered secure, private or confidential. Many organizations, including the Provincial Health Services Authority (PHSA), have policies that prohibit sensitive information from being sent electronically.
BCCDC was initially granted a temporary exemption to the PHSA policy to pilot the Email and Text Guidelines in a clinical setting (October 2015 – January 2016). The guidelines were then updated with feedback from the pilot and from internal / external stakeholder review, and BCCDC was allowed to operationalize the guidelines with an ongoing exemption from the PHSA policy.
The finalized guidelines have since been shared on request within PHSA and the Regional Health Authorities.
Piloting email and text communications
All nominal patients presenting to the clinic for STI screening were offered the option to receive their results in person, over the phone, or through email. Patients preferring email were required to sign a client consent form and advised that they must email the Provincial STI Clinic to request their results (for negative results) or that a BCCDC nurse will contact them (for positive results).
Negative results for chlamydia, gonorrhea, syphilis (excluding previously positive), HIV and hepatitis C screening were available through email. Positive STI and HIV results were delivered in person or over the phone, or in special circumstances, through email with a manager’s approval.
Patients receiving their results by email were also invited to participate in an online survey to give feedback about their experience.
Text
All patients presenting to the clinic for STI screening were offered the choice of contact with clinicians either in-person, over the phone or through text messaging. An “opt out” strategy was followed; if a patient provided a phone number, they were provided with a Client Acknowledgement Statement and could opt out of receiving text messages.
Text messaging was used for administrative, health education and health promotion purposes (e.g., asking a patient to contact the clinic). Negative and positive STI/HIV results were only delivered through text with patient consent and a manager’s approval.
Patients were only contacted though text messaging when it was the client’s only preferred method of contact or at least one other means of contact had been previously attempted.
Evaluation
Uptake
The number of patients opting to receive communications by email and/or text indicates a desire to communicate electronically with the Provincial STI Clinic.
- 64% of patients opted to receive their results by email (376 offers/240 consent forms signed).
- 70% (168/240) of those patients signing a consent form subsequently emailed BCCDC to request their results.
- 89% of patients agreed to receive text communications (625 offers/555 did not opt out).
No adverse events were reported during the pilot. To-date, no privacy breaches or other patient safety events related to email or text communication have been reported.
Acceptability
Acceptability among patients participating in the online survey (during and post-pilot) was high; 93% of those that responded reported a positive experience with receiving their results by email.
Nursing staff at the Provincial STI Clinic were also invited to participate in a pre- and post-pilot survey. The majority of nurses surveyed felt that patients should have the option of receiving test results by email and text. A high proportion of nurses were interested in helping patients receive results electronically and felt that this would improve the clinic’s ability to meet patient needs.
Conclusion
The email and text pilot demonstrated a number of key findings:
- Clients are generally in favor of receiving communication by email and/or text.
- Clinical managers appreciate clear guidance to support appropriate use of email and/or text by nursing staff
- The use of email and text communication thus far has not resulted in any patient safety events.
The BCCDC Staff Guidelines: Email and Text Communication with Clients provide staff and leadership direction on safer communications with clients by email/text.