The College Council recently completed a sunset review of the guideline “Patient-Physician Communication Using Electronic Communications”.  This guideline had last been amended in 2015; given the significant developments in technology and electronic communications since that time, the Council appointed a committee to undertake a detailed review.  Once the Council had approved the committee’s suggested amendments in principle, the College conducted stakeholder consultation on the proposed guideline and the committee then recommended additional amendments to Council.  The Council approved the updated guideline – with its new title “Physician Use of Electronic Communications” – at its November 2021 meeting.

As described on the CPSS website, a guideline describes practices that are “generally recommended by the Council of the College as part of providing quality medical care in a professional manner.”  Physicians are encouraged to follow the recommendations included in the guideline, but can exercise reasonable discretion in their decision-making based on the guideline. If a physician decides to deviate from what is described in a guideline, the reasons should be documented in the patient’s medical record.

In general, the amended guideline is intended to address the overarching principles that apply to any form of electronic communications when personal health information (PHI) is being transmitted, and to assist physicians in understanding their legal, professional and ethical obligations when using electronic means to communicate PHI.  This includes concerns with privacy, confidentiality and security of information.  While physicians are encouraged to review the guideline here, some of the guiding principles follow:

• Physicians are responsible for the safe and effective management of the PHI of the patients in their care;
• While physicians are encouraged to avail themselves of the advantages that come with electronic communications, they must be aware of the risks inherent in using those tools to communicate PHI. These risks apply whether the physician is communicating directly with the patient, or with another medical colleague in relation to a patient’s care.
• When using electronic communications, physicians must ensure the security and confidentiality of the PHI conveyed, and must also ensure the proper storage/recording of that information in the patient’s medical record.
• Physicians should consider the relative risks of communicating PHI electronically, and the safeguards that are necessary depending on the sensitivity of the PHI being communicated and the mode of transmission.
• Patients’ consent should be obtained prior to using electronic communication tools (other than telephone) to communicate PHI to patients. Consent should be documented in the medical record.

In addition to the guiding principles, the guideline also addresses specific issues physicians should consider when utilizing a number of different types of electronic communication tools including fax, email, text/picture messaging, and online video consultation.   Some of the common themes include the following:

• Physicians should consider de-identifying PHI to be sent by email or text/picture messaging;
• PHI should only be sent by secured or encrypted email (or as a password-protected attachment);
• Recipient contact information should be confirmed prior to sending PHI; and
• Physicians must determine how to retain electronic communications in their medical record and also how to ensure destruction of the PHI that may remain on their electronic devices.

While the guideline does briefly address the use of electronic communication tools to conduct virtual appointments (either by telephone or video), this is addressed in only a cursory way.  Physicians are reminded to consult the policy “The Practice of Telemedicine” for a more comprehensive overview of the College’s expectations of physicians providing care by virtual means. 

For any physicians who wish to undertake more reading in relation to the important considerations in using electronic communications, the guideline includes a detailed “Other Resources” section that contains links to many other sources of information relating to these topics.