Why Medical Care Cannot Be Offered Over EMR Messaging Systems
Medical care should not be provided over messaging EMR systems because it lacks the necessary security, confidentiality protections, and closed-loop communication required for safe and effective healthcare delivery. 1
Security and Privacy Concerns
Electronic communication of health information requires specific safeguards that typical messaging systems often lack:
- Standard EMR messaging systems may not provide adequate encryption and security to protect patient health information 1
- Unsecured communications risk HIPAA violations and potential breaches of protected health information 1
- Healthcare teams should only use secure platforms that protect communications with patients and incorporate information directly into the standard EHR 1
Clinical Limitations of Messaging Systems
Messaging systems have significant limitations for providing medical care:
- Electronic communication should not be used in isolation to provide medical care unless there is confirmation of receipt and comprehension ("closed-loop communication") 1
- Text-based communication lacks visual and verbal cues that are essential for proper assessment 1
- Changes in therapy, providing test results, or discussing diagnoses are more safely accomplished through face-to-face or verbal communication that allows for real-time clarifying questions 1
- Asynchronous communication creates risks of delayed responses to urgent medical issues 1
Documentation and Accountability Issues
Proper documentation is challenging with messaging systems:
- Medical decisions require proper documentation in the medical record, which may be difficult to achieve through messaging 1
- Patient consent and awareness of security risks associated with electronic communication must be documented in the medical record 1
- Physicians should not use personal email accounts or unsecured messaging for patient communications 1
Patient Safety Considerations
Patient safety may be compromised through messaging-only care:
- Patients with greater disease severity or serious illness are less inclined to use portal communications effectively 1
- Complex medical issues require in-person assessment to ensure proper evaluation 1
- Messaging systems may create a false sense of security for patients with urgent medical needs 1
- The potential for misinterpretation of written instructions is significant without the ability to confirm understanding 1
Legal and Regulatory Risks
Providing care through messaging creates legal vulnerabilities:
- Physicians must be aware of legal requirements in their states regarding electronic communications 1
- Risk for state medical board violations exists if physicians provide care to patients in states where they are not licensed 1
- Failure to maintain confidentiality of sensitive information can lead to fines or adverse licensure actions against individual physicians 1
Appropriate Use of Electronic Communication
While full medical care cannot be provided via messaging, electronic communication can supplement care when:
- Used to enhance established in-person care relationships, not replace them 1
- Incorporated with clear expectations between medical teams and patients 1
- Supported by communication agreements that establish boundaries and expectations 1
- Used for non-urgent matters such as appointment scheduling, medication refills, or general questions 1
When explaining these limitations to patients, emphasize that the restrictions exist to ensure their safety and the highest quality of care. In-person or synchronous verbal communication remains essential for proper assessment, diagnosis, and treatment planning.