Legal & Ethical Processes for Choosing Digital Communication Tools for Healthcare

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As an increasing number of healthcare technologies are gaining visibility in the marketplace, providers are often bewildered about choosing the right tool for the right job. When it comes to healthcare communication, choices are not only confusing, but many vendors tend to overlook different legal and ethical requirements as well as specific clinical needs experienced by various provider groups.
Wrongly assuming that all healthcare providers and their needs are the same, many vendors develop their technology with a few “use cases” in mind. Granted, the breadth of situations served by behavioral healthcare can be daunting, but awareness of legal and ethical compliance need not be overly complex. For instance, most privacy rules are managed by HIPAA compliance, but then again, some states have rules above and beyond HIPAA. Regardless, meeting compliance requirements is not optional for providers in those states. Vendors should make more effort to assure providers that their state’s laws are followed. Similarly, Business Associate Agreements (BAAs) for each technology used are required of all licensed professionals, regardless of setting, specialty, or state. Vendors who don’t offer BAAs are not likely to make this fact known if providers don’t ask, despite their outright pitch to these same providers.
The biggest failure of vendors seeking to sell their wares to behavioral professionals is their lack of awareness regarding the potential lethality of the populations served by behavioral providers. Mentally ill and substance use populations can be abusive – to themselves, to others, and to their providers or their organizations. They also can be lethal to themselves, other people, their providers, and the organizations trying to help them.

How Digital Communication Vendors Can Better Serve Behavioral Providers

Vendors who wish to advance their technology to behavioral clinicians then would be wise to consider the need for added protection when suggesting that health communication technology such as bulk email, texting, and websites be used to quickly and easily replace human communications in medical vs behavioral settings. More specifically, primary care offices have a different set of health communication requirements than independent practitioners in behavioral health. This article reviews some of the most promising new uses for providers and their organizations using email, texting, and websites while keeping an eye on ethical mandates for safe and professional use.

Differences To Consider When Using Health Communication Technologies such As Email, Texting & Websites

Providers and their organizations are encouraged to consider these three issues when find new uses for healthcare communication technology:

  1. When choosing digital communication software, choices must be made with regard to the needs of each population served rather than simply comparing features of one technology over another. Are the individuals being served currently housed in a substance use treatment center, or are they traveling from state to state as a trucker? Are they living in a fracking field in South Dakota, or are they living in their own homes in a suburb? Do they have reliable WIFI or wired connections? What are their technology preferences? The location of the care recipient, their needed services, their available connectivity, and who is exercising authority over them will dictate a provider’s choice of digital communication tools as much as a list of software features.
  2. Next to consider is the setting of the provider. Is the practicing professional working from a private home, a primary care office, a local high school, or a battered women’s shelter? Does the provider travel to and from grammar schools, the court, local prisons, or senior care facilities? Are they using a hot spot on their phone, a virtual private network, or local unsecured WIFI? Do they have safety protocols to handle any problems whenever they are?
  3. Digital health communication software choices and their rationales should be documented. What needs to be documented, and who will have access to that documentation? Safety protocols for using each technology should be part of the record and staff training. Staff healthcare technology training should not only include specific instructions for basic workflows but, equally important, how to maintain patient and client safety as well as convenience. What could go wrong with privacy? Who has which level of access? Why? Does the technology provide tutorials for consumers? Do those tutorials offer a diversity of people using the technology in a variety of settings? Are standard operating procedures (SOPs) developed for all aspects of healthcare delivery, including setting, patient need, and provider? Are these SOPs well-practiced and readily available in case something goes wrong? Communicating about and setting healthcare appointments, both in-person and via telehealth, making resources available and accessible, and issuing reminders.

Now that the pandemic is shifting, it may be time for providers and their organizations to consider these issues as they make permanent choices regarding how to streamline and secure their healthcare communications. They may also want to revisit providers’ ethical codes with an eye to safety when using them for routine administrative tasks, including setting appointments. Below, healthcare is discussed critical considerations for developing seamless and easily accessible digital communication options.

Offering a Variety of Digital Communication Options

Digital healthcare has officially arrived in many previously unimagined forms. Email and text messaging services are known as “push technology,” whereby information is delivered to a designated recipient rather than waiting for them to visit a static technology such as a website. This article will discuss both push and static technologies and how to use these 21st Century tools to augment clinician service offerings.
Emil and text messaging services are available as stand-alone services or part of more comprehensive platforms that include video conferencing, patient engagement tools, patient portals, e-visits, and more. Note: before searching elsewhere, the reader is encouraged to consider checking with their current video service providers to determine whether any of the systems discussed below are available through their existing service packages.

Bulk Email Systems

Providers can now efficiently deliver generic, informational, HIPAA-compliant email newsletters or updates by using bulk emailing systems to announce additional services, such as the availability of virtual tools to augment real-time communication. These systems can remind existing clients and patients of local and Internet-based resources for various issues, along with emergency numbers, battered women’s shelters, office phone numbers, and office policies. Providers can use them to announce additional flexibilities offered by a clinical office, either the availability and benefits of joining video sessions or the option to schedule occasional in-person meetings for established telehealth clients. Such systems might also be used to disseminate announcements of upcoming office closures due to holidays or other events and convenient alternative scheduling options if appropriate.

Text Messaging for Immediate Patient Communication

Many clients and patients appreciate the privacy and immediacy of receiving text messages from their providers. Changes to appointments and patient monitoring are other ways that make texting an excellent form of communication in healthcare. Additionally, providers can save on administrative help when they utilize texting while minimizing their time communicating with clients since sending a text is fast and convenient for the provider.

Patient Portals As Part of EMR Software

Patient portals are sometimes referred to as patient engagement tools. Both are being used by providers and their organizations to ensure secure and protected healthcare communication. Some are stand-alone technology platforms, and others are made available as part patient portals are dedicated parts of EMR Software. These systems allow patients and clients to access health services and information in their own time when needed and shared with others. Some platforms allow clients and patients to set different permissions to give a level of access to their spouse and a different level to their speech and language therapist. Parties, including the client or patient, may be invited to participate in a survey, an assessment, or view reports and lab results. Patient portals also provide options to schedule appointments, pay for office visits and review their overall account. Overall, this communication tool increases patient involvement in their healthcare, makes it available when and where they need it, and reduces telephone or surface mail communications that require staff members to fulfill needs and requests.

Digital Communication in Healthcare: Website for Your Practice

A provider website can be optimized to create an excellent HIPAA-complaint communication experience for all involved parties. Clinicians can post updates and important information that will impact their clientele’s ability to attend appointments and receive care. Many providers find it helpful to create a specific page dedicated to such information and allow patients to ask questions or read through a FAQ page. Links to helpful resources can also be located on the website. An option to make a telehealth appointment on the website and specify the type of service requested can also improve communication and ensure smooth telehealth service delivery and convenience in scheduling. Whether in-person or telehealth services are offered, a map with directions to the office and pictures of the office exterior and interior also helps to make consumers feel safe and welcomed. However, if exclusively providers work from their homes, this information may be best omitted.

Benefits to Offering Digital Communication in Healthcare

High-quality and reliable patient communication leads to greater patient satisfaction, better appointment outcomes, and market share increases. Patients feel a greater sense of knowledge and control over their health when the right tools facilitate communication with their providers and organizations. When choosing digital strategies to enhance digital communication, providers must apply appropriate informed consent. Good communication in healthcare also contributes to public safety, prevention, and greater satisfaction for both patients and providers.

Ethics: Social Justice, Informed Consent & Protections

Many issues surface when offering digital communications in telehealth, teletherapy, speech and language, and many other therapies. By using bulk email dissemination, healthcare providers must always be mindful of the need for static or dynamic informed consent issues with appropriate written releases before sending such communication. Opt-in forms can either be developed by the provider or found as built-in functions of new patient communication services. Particularly in delivering behavioral healthcare, clinicians who fail to fully inform users of associated risks and benefits may put uninformed clients and patients in potentially lethal situations if others intercept such emails. It is prudent and advised to discuss how intercepted information sent from a behavioral office may endanger the recipient.
Similarly, when choosing what, when, and who will receive which information, forethought must be given to how a patient’s friends or family access to their email and text messaging might compromise their privacy. Behavioral clinicians then must be prudent when inviting clients and patients to receive such information. In some cases, the information will be appreciated and welcomed. In others, it could be life-threatening if, for example, an angry, abusive friend or family member accesses information that potentially triggers confrontation or assault. Factors to consider might include the age of the client or patient, their history and current circumstances, their setting, their diagnosis, their judgment, and their preferences. In any case, judicious use of language that does not directly suggest that the recipient is currently receiving care from the provider may also be essential to consider. Offering healthcare communications by email can be an effective and informative means of maintaining good communication in healthcare.

Basic Telehealth Legal Issues: Rules, Regulations & Risk Management

Bring your telehealth practice into legal compliance. Get up to date on inter-jurisdictional practice, privacy, HIPAA, referrals, risk management, duty to warn, the duty to report, termination, and much more!

Disclaimer: The Telebehavioral Health Institute (TBHI Telehealth.org) offers information as educational material designed to inform you of issues, products, or services potentially of interest. We cannot and do not accept liability for your decisions regarding any information offered. Please conduct your due diligence before taking action. Also, the views and opinions expressed are not intended to malign any organization, company, or individual. Product names, logos, brands, and other trademarks or images are the property of their respective trademark holders. There is no affiliation, sponsorship, or partnership suggested by using these brands unless contained in an ad. We do not and cannot offer legal, ethical, billing technical, medical, or therapeutic advice. Use of this site constitutes your agreement to TBHI Privacy Policy and Terms and Conditions.

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