Physician's Ethical Duty: Deleting Patient Portal Messages

Patient portals have become an increasingly popular method for patients to communicate with their physicians, access their medical records, and schedule appointments. While this method of communication has many benefits, it also raises concerns about patient confidentiality, data security, and potential physician misconduct. In the context of physician discipline, the question arises whether a physician deleting patient portal messages could be considered willful and wanton misconduct. This issue is particularly relevant in light of state laws that require the reporting of any suspected misconduct by health professionals, including instances of improper filing, document disposal, and unauthorized release of information.

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Patient portals improve communication, registration, and patient care

Patient portals are an effective way to improve communication, registration, and patient care. They provide patients with convenient and flexible access to their healthcare provider, enabling them to securely message their physician, schedule appointments, request prescription refills, and access their medical records from anywhere with an internet connection. This accessibility promotes patient engagement and empowerment, allowing individuals to take a more active role in their healthcare journey.

One of the key benefits of patient portals is the improvement in communication between patients and healthcare providers. The secure messaging function enhances the patient-physician relationship by providing a direct line of communication. This enables patients to ask questions, seek clarifications, and receive timely responses to their queries. Additionally, patient portals help minimize the risk of miscommunication and reduce the need for follow-up questions by providing centralized and consistent after-visit information.

Patient portals also streamline the registration and administrative processes. Patients can efficiently complete pre-visit forms and update their personal and medical information remotely, reducing the time spent on paperwork during in-person visits. This optimization benefits both patients and healthcare providers by freeing up time for more meaningful interactions during appointments.

Furthermore, patient portals contribute to improved patient care. Healthcare providers can utilize patient portals to facilitate the quick delivery of test results, enhance medication adherence, and provide patient-specific education resources. The portals also enable providers to better manage their revenue cycle by offering online payment options, resulting in faster and more complete payments. Additionally, patient portals can be particularly advantageous for individuals with chronic or long-term health issues, enabling them to access their health information and communicate with their providers conveniently.

While patient portals offer numerous benefits, it is important to acknowledge the challenges associated with their implementation. Some patients may be unaware of the available portal options or may find the registration process cumbersome. Promoting the use of patient portals and providing clear instructions and support can help address these challenges. Overall, patient portals have the potential to revolutionize healthcare by improving communication, streamlining registration, and enhancing the quality of patient care.

Patient messages contain sensitive information

Patient messages often contain sensitive information, and it is imperative that physicians handle this information with care. In the US, the Health Insurance Portability and Accountability Act (HIPAA) gives patients rights regarding their Protected Health Information (PHI). Patients have the right to state how they want their PHI to be handled and communicated to others. For example, a patient may request that messages from a hospital be sent by mail to their private home, rather than being left on their home phone.

HIPAA rules also allow patients to inspect and review their PHI. If a patient perceives an error in their PHI, they can request a change. For example, a patient may want a diagnosis deleted from their medical chart after receiving treatment.

In addition to these rights, patients can also request that healthcare providers communicate with them by alternative means or at alternative locations, as long as the request is reasonable. For instance, a patient may prefer to receive appointment reminders via email rather than on a postcard. If a patient requests confidential communications, the provider should accommodate this request by offering alternative means of communication, such as secure electronic methods, mail, or telephone.

With the widespread use of electronic communications, it is crucial to ensure compliance with the HIPAA Security Rule requirements. This includes implementing safeguards to protect health data and seeking advice from HIPAA compliance experts when needed.

While most violations of HIPAA rules cannot be addressed through patient lawsuits, gross negligence and professional malpractice can be grounds for legal action. Healthcare providers should seek professional help and develop a code of conduct booklet outlining the policies and procedures to prevent HIPAA violations.

In summary, patient messages frequently contain sensitive PHI, and physicians must adhere to HIPAA regulations when handling this information. Patients have rights under HIPAA to control the handling and communication of their PHI, inspect and request changes to their PHI, and choose alternative means of communication to ensure confidentiality. Non-compliance with HIPAA can have legal implications, and healthcare providers should take proactive measures to prevent violations.

Misconduct includes harassment, abuse, or intimidation

Misconduct in the workplace includes harassment, abuse, or intimidation. Harassment is defined as unwelcome conduct that is based on an individual's protected status or protected activities. Protected status includes an individual's race, colour, religion, sex, sexual orientation, national origin, age, disability, family medical history, parental status, and political affiliation. Protected activities include complaining about discriminatory or harassing behaviour, disclosing or reporting violations of laws, rules, or procedures, and participating in discrimination or whistleblower proceedings. Harassment can be carried out by a supervisor, a supervisor in another area, a co-worker, or a non-employee such as a client or customer.

Harassment becomes unlawful when enduring the offensive conduct becomes a condition of continued employment, or when the conduct is sufficiently severe or pervasive to create a work environment that a reasonable person would consider intimidating, hostile, or abusive. This includes offensive jokes, slurs, epithets, name-calling, physical assaults or threats, intimidation, ridicule, mockery, insults, put-downs, displaying offensive objects or pictures, and interfering with work performance.

Abuse is defined as the improper usage or treatment of a person, often to unfairly or improperly gain benefit. Intimidation is defined as the act of making someone feel frightened or threatened, especially to make them do something that you want.

In the context of physician discipline, misconduct includes the willful harassment, abuse, or intimidation of a patient, either physically or verbally. Summary suspension of a physician's privileges for sexual harassment is justifiable when there is a reasonable basis to conclude that there is a danger of the physician's misconduct. State law requires health facilities to report disciplinary actions taken against medical professionals and any other instances of possible misconduct. All licensed health professionals are required by state law to report colleagues whom they suspect may be guilty of misconduct.

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Misconduct must be reported to OPMC

Misconduct complaints are a common occurrence in the medical field, with more than half of all complaints about physicians and physician assistants coming from the public, including patients, friends, and family members. State law requires health facilities to report disciplinary actions taken against medical professionals and any other instances of possible misconduct. All licensed health professionals, including physicians, physician assistants, and specialist assistants, are required by state law to report colleagues they suspect may be guilty of misconduct.

If you believe a colleague's actions may constitute misconduct, you must contact OPMC. If the colleague is affiliated with a hospital, a report can be made to the facility's professional practices committee, which must then inform OPMC. If the colleague is not affiliated with a hospital, a report can be filed with the county medical society, which will be responsible for reporting to OPMC. Failure to report suspected instances of misconduct is, in itself, misconduct.

If you are uncertain whether specific actions or behaviours constitute misconduct, you may request advice from OPMC without revealing the name of the practitioner. Once OPMC provides an official response, you are required to follow it. Practitioners suspected of having problems with alcohol, drugs, or mental illness but whose ability to practice is not impaired may be reported to the Committee on Physicians' Health of the Medical Society of New York (the committee). The committee identifies, refers to treatment, and monitors impaired physicians. The program is voluntary and confidential. The names of physicians participating in the program are not shared with OPMC without their approval unless there is a failure to comply with treatment recommendations.

When a complaint is filed with OPMC, there is a procedure in place to weed out any complaints that lack foundation or fall outside the jurisdiction of OPMC and the board. If evidence of misconduct is found, checks and balances in the medical conduct system assure physicians due process. OPMC has the authority to investigate any suspected professional misconduct and must investigate each complaint received, regardless of the source. An investigation is opened, and interviews are conducted to gather more information. Physicians must cooperate fully with investigations, and they can have legal counsel present during interviews and at any time during the investigatory process.

Patient portals can cause physician burnout

Patient portals have been shown to improve patient-physician relationships and increase patient loyalty. However, they have also been linked to physician burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of a sense of personal accomplishment. More than half of physicians in some studies have reported experiencing burnout.

The increasing use of patient portals has contributed to this burnout by challenging physicians' work-life integration. The adoption of electronic health records (EHR) has reshaped how physicians work, with a significant amount of their time now spent working on computers outside of visits. This includes documenting patient visits, reviewing laboratory test results, renewing medications, and responding to messages from patients and clinical staff. The time spent on these tasks can detract from the time spent with patients, adding an extra layer of administrative burden and reducing the time available for self-care and a healthy work-life balance.

The pressure to respond to a deluge of inbox messages in a timely manner can be stressful, and if not managed correctly, can negatively impact patient care. Burnout can lead to physicians leaving practices, threatening patient safety and care quality. Depersonalization may result in poor interactions with patients, and impaired attention, memory, and executive function in physicians.

However, patient portals can also reduce burnout if optimized effectively. By shifting some tasks to patients, such as completing intake questionnaires and entering remote monitoring data, the workload on physicians can be lessened. Additionally, reducing physician panel sizes, increasing flexibility for longer patient visits, and increasing care team staffing have been shown to improve work satisfaction and reduce burnout rates.

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