Communication Electronic communication has become one of the most important methods for people to communicate with one another in recent years. Spielberg (1999) noted that patients have sought to utilize electronic communication with their physicians. In the past, he argued, a variety of exchanges were utilized, including in-person visits, telephone, pagers and voicemail, so it was only natural that communication between patients and those within the medical profession would be extended to the realm of electronic communication. Thus, the market has driven the need for health care organizations to begin to explore how they can use electronic communication methods such as email, the Internet, online chats or even SMS messaging to bridge the communication gap with their patients. While the market may demand new methods of communication be developed, there are risks inherent to the medical profession that present challenges or obstacles to facilitating the market-demanded electronic communication methods.

The Issues

One of the most important issues with respect to the health care profession and clients in particular is in electronic health care records. There is a move in the industry to put more health care records into electronic format. Any record that is in electronic format can, logically, be delivered to any number of people over the Internet. Normally, with paper records, this is not the case. Patients increasingly want access to their records, but there are also issues that need to be considered with electronic health records that are being transmitted from one health care organization to another, or even within a single health care organization.

In general, patients prefer to have electronic access to their health care records. There is the sense that care is improved if both the patients and other health care providers have access to a patient's records, and online communication of these records is the fastest and most efficient means of communication. Some studies have shown that patients prefer e-mail and other forms of electronic communication for routine transactions, like prescription renewals, but for more complex or serious transaction patients typically prefer in-person communication (Hassol et al., 2004). The implication is that health care organizations need to focus their electronic communication primarily on such routine transactions. This inherently reduces the risk to the patient of security issues in electronic communications, since the more serious communications with the most sensitive information will not take place online.

Since the use of electronic communication mechanisms in health care tends to be patient-driven, it is important to understand how patients want this information used and transmitted. The Hassol study highlights some usage patterns. Winkenheim, Leonard and Rossos (2005) note that "patient use of electronic medical records (EMR) holds the potential to improve health outcomes." There are four reasons for this that the authors cite: "promotion of a sense of illness ownership, of patient-driven communication, of personalized support, and of mutual trust." If patients feel that they have some control over the process of dealing with their illness, they will experience better outcomes. For many patients, exerting this control means using methods of communication with which they are most familiar. Younger patients in particular prefer the use of electronic communication for dealing with their health care organizations.

For the health care organization, there are a few different ways in which value is derived from electronic communication of medical records. The first is that it meets patient needs. If patients prefer this form of communication, over time the market forces will direct more business to the organizations that deliver on this patient need. Realizing that demographically, the first generations that are savvy with electronic methods of communication are not yet in their prime health care-consuming years, there is time for the industry to adapt, but adapt it must because when these generations become major health care consumers they will demonstrate strong preference for the health care organizations that meet their communication needs. In addition, Winkenheim et al. (2005) noted, health outcomes are improved. Electronic health care records can be transmitted by the customer to other health care providers, shortening the period for the transfer of these files, and enabling multiple health care providers to have these files simultaneously. Superior health care outcomes for patients reduces liability for the health care provider, and the longer patients live the more health care they can consume. Thus, there is a strong case both in terms of health outcomes and the bottom line for health care organizations to embrace...

Annas (2003) notes that the passage of the Health Insurance Portability and Accountability Act (HIPAA) represents a significant change in the approach to managing the privacy of health care information. HIPAA is subject to modern interpretation and adaptation to bring it into the electronic age. Health care organizations are bound to follow the terms that HIPAA has with respect to maintaining the privacy of patient medical records, even if those records are electronic in nature and being transmitted via electronic means. Health care organizations must be alert to means of encrypting files and emails, and to web site security issues, before implementing any program to increase the use of electronic media in the transmission of health medical records.
Health care today is already seeing positive impact from the use of electronic means of communication between health care organizations and patients. Patients use their health records in a number of ways that are only made possible by the electronic dissemination of the records. Cimino, Patel and Kushniruk (2002) note that some patients take advantage of having access to their medical records by accessing these records sometimes more than once per day. Patients almost always use this access to review their laboratory results. Patients, as a result of this communication, tend to understand their conditions better. This not only improves the patient's outlook towards their treatment, but it improves the quality of communication that the patient has with the medical staff. Improved communication is one of the major factors affecting outcomes, so better communication tends to lead to better medical outcomes.

Another benefit of increased use of electronic communication like email or the Internet to communication health records is that it facilitates improvements in distance medicine. Medical practitioners are better able to reach patients who are otherwise remote and may find it difficult to travel constantly to their health care providers, who are often located in towns and cities. When patients have the ability to communicate with their providers online, they can receive more frequent communication and therefore better care. Ralston, Revere, Robins and Goldberg (2004) note that patients using interactive electronic health records and web-based diseased management programs experienced the following superior outcomes: enhanced sense of security about health and health care; a feeling that non-acute concerns are uniquely valued; feeling better able to manage and valuing feedback. Ironically, these patients also noted that it was difficult to fit the program into daily life, apparently feeling that visiting a medical facility on a daily basis is more convenient.

The Next Five Years

Five years from now, health care will rely even more on electronic medical records than it does today. There is a major transition in the industry to electronic medical records, and as more institutions adopt EMRs, they will seek to use those records in ways that improve numerous outcomes. It has been established that electronic transmission of health records improves a number of outcomes, including patient outcomes and patient satisfaction. Organizations in the health care industry are going to be almost entirely on electronic medical records in the next five years.

The transition to EMRs will be met with an increased usage of electronic means of communication. The baby boom generation is entering its peak consumption years for health care, and many members of this generation are quite functional with electronic communication. They will demand that health care organizations meet their needs, and this means that more organizations will need to utilize e-mail and other electronic transmission mechanisms more frequently. This will give rise, however, to whatever issues might come about such as those with respect to privacy and security. One of the results of this is that health care organizations are likely to need to spend much more in the next five years on addressing the security of electronic medical records. As HIPAA's passage gave rise to an entire HIPAA consultancy industry, surely the same will occur with the security of electronic medical records.

In particular, the industry will need to ensure that emails are secure, when they contain personal health information. Perhaps even more challenging will be ensuring the security of direct communication via open chat channels and voice over Internet protocol (VoIP) services (such as Skype). While it is convenient for all stakeholders to be able to have a physician and patient go over a chart or report remotely, that communication if conducted over the Internet will typically have a low level of security. For the industry to meet the…