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Feature: NHS Email Communication

During a speech recently at a NHS England conference Matt Hancock outlined ambitions for healthcare staff to email patients directly with information on appointments to reduce delays and cut costs in paper and postage.

In the speech Hancock said “Email is as secure and cheaper than communicating through paper and fax machines.”

We asked the tech industry and professionals working in NHS Trusts and General Practice for their views.

Contributors include: Dr Hussain Gandhi, Allscripts, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Sherwood Forest Hospitals, Channel 3 Consulting, Difrent, Draper & Dash, Ingenica Solutions, InfoFlex, Elsevier, Deontics and Enovacom.

Dr Hussain Gandhi, GP based in Nottinghamshire, founder of egplearning

“Recently the secretary of State for Health and Social care Matt Hancock issued a clear mandate that email should be the form of communication with patients moving forward instead of posted letters. This has caused a lot of discussions particularly in the wake of his previous comments about abandoning faxes and more recently stopping the use of pagers in hospitals.”

“Using email as a method of communication has clear advantages. It is free, nearly instantaneous and will arrive at the correct address. This has clear benefits over the postal system which can take several days and can be mailed incorrectly to a different address or neighbour and cost significant amounts in postage. Compared to faxes which have a poor method to reply and require the use (or waste) of several sheets of paper including cover sheets. Email provides benefits to patients as it can allow portable access to content that has been sent like clinic letters, the ability for patients to formulate their needs or concerns and a communication method that may benefit particular groups of patients like those with language challenges.”

“However, the seeming simplicity of this directive is challenging. Many hospitals and practices that do not use email as a primary method of contact will have to create protocols and processes to enable this method of communication to be effective. Also overcoming the fear of a data breach, particularly in the wake of GDPR is a key concern that can drive the fear of change.”

Additional challenges include:

  • Ensuring the email address collection is correct to ensure appropriate delivery
  • Supporting the patient to see important emails via whitelisting organisations like the practice or hospital email address and bypassing junk filters
  • Enabling processes to deal with clinical replies, particularly if the communication method is not monitored 24/7 ie a patient replying to ask about clinical symptoms.
  • Disclaimers and warnings about sharing information.
  • Ensuring enough time is allocated for dealing with the additional workload of an additional communication channel.

“Matt Hancock has suggested one change, which is that NHSMail is no longer the only mail service that needs to be used to communicate with patients, but details on other specific or commercial systems are not clear, despite the criteria existing. Clarity and guidance on the above, including sharing of information, may help to further reassure practices and hospitals wanting to use email as a form of communication with patients.”

David Walliker, Chief Information Officer, Royal Liverpool and Broadgreen University Hospitals NHS Trust

“We believe this is a major step in the right direction. This is subject to acknowledging that digital excluded patients will require traditional methods, but we are working towards a regional portal for Cheshire and Merseyside which will enable communications via this medium for patients who opt for it and this will replace paper communication.”

Richard Strong, Vice President and Managing Director EMEA, Allscripts

“Email is more secure than snail mail, and it’s possible to set up systems that would allow patients to pick up communications from a secure site; banks and utility companies already do this. So, I am not worried about the security aspect.”

“What I am concerned about is that email is not part of the patient record. It is not structured, so it can’t be sent straight into another providers’ system, it’s not coded, so it can’t be used for analysis, and it’s not triggered as part of the clinicians’ workflow.”

“We should definitely be moving away from sending letters. But in doing that, we should be moving towards using the EPR and the publishing through a solution like Allscripts’ FollowMyHealth or HealthGrid. These not only enable patients to pick up results and letters, but let them engage with their clinicians through secure messaging if necessary.”

“We shouldn’t be looking to just replace letters with emails. We should be looking to make sure that communication with colleagues and patients flows from the workload of clinicians, remains part of the clinical record, and can be used for research and analysis as well.”

Morgan Thanigasalam, Clinical Lead for ICT, Sherwood Forest Hospitals

“Sherwood Forest Hospitals Trust is increasingly aware that technology should be used to help communicate with patients and is part of Connected Nottinghamshire, a digital programme supporting the Nottingham and Nottinghamshire ICS technology enabled care workstream, which is working towards Public Facing Digital Services.”

“Our system wide vision across Nottinghamshire is to transform the way people experience access to health and care services across Nottinghamshire, by providing digital health tools and services that connect them to the information and services they need, when they want them. We want to enable people to access care in a convenient and coordinated way, promoting independence through the digital tools we are all familiar with in other aspects of our daily lives.  This will see patients being able to communicate with us about appointments and administrative issues in the way they run the rest of their lives. To ensure success of our part in this national vision, there has been wide scale public consultation and active public involvement with the programme and the use of emails (with consideration around education and alternative communication routes) is an early focus.”

“In order to support the delivery of this vision and enable the benefits of Public Facing Digital Services to our whole population, digital inclusion will be a key factor to its success.  By understanding some of the challenges faced by the population of Nottinghamshire who experience digital exclusion we are able to support them in accessing online digital services and utilising the services available to them.  We will be utilizing, where possible, existing digital inclusion support mechanisms such as basic digital training, engagement events such as pop up shops and digital inclusion champion networks for the population of Nottinghamshire.”

Jessica Bradshaw, Managing Partner, Channel 3 Consulting

“The aspiration to offer channels to access health care that reflect the channels we use to access other important services in our lives is a positive one. Using applications and email to engage with other public services is becoming increasingly popular, and with the right, secure, infrastructure in place, email communication with clinicians ought to be feasible. However, there are a host of other issues to consider beyond the technology itself.”

“We must be mindful not to marginalise those who can’t readily access digital services – the NHS will need to continue offering multiple channels of access if we are to ensure those who don’t or can’t use technology are not disadvantaged. Furthermore, we need to be clear where electronic communication can add value, particularly for more administrative correspondence, and where it might not be appropriate. Clinicians will need support and training in how to make effective use of email without risking correspondence overload, and organisations will need to have policies and protocols in place for the monitoring, storage and security of electronic communication.”

“As is often the case with any move towards digitisation, there are lots of potential positives, but we need to be clear about what, how and when to use email versus paper or face to face communication.”

Daniel Leakey, Delivery Lead, Difrent 

“The historical use of post by the NHS due to it being the “only” secure method of communication with patients is simply no longer correct. Even without taking into account modern encryption methods, email is in many practical ways, more secure than post. There is no such thing as a completely secure system, what is important is how any risks identified within it are mitigated.”

“It’s our opinion that if you were to ask the average NHS patient under 40 for their preferred method of contact, it is likely to be email. That email is most likely to be read on a smartphone which is unlocked using either a pin code or some form of biometric identifier, via an email account that can utilise two-factor authentication. If confidentiality is the priority, then these protections surely have to score higher than an envelope dropped through a letterbox?”

“There will, of course, be those that still feel safer receiving post than an email and these wishes should be catered for, but there should certainly be an option to be contacted by email. There are financial and environmental savings to be made by this and potentially huge efficiencies too, it makes no sense for the NHS not to embrace email.”

Orlando Agrippa, CEO and Richard Parker,COO, DRAPER & DASH

“Here at D&D central we were discussing that letters from the NHS remain the last bastion of formal postal communication. Utility bills, bank statements, the TV license etc became part of an online, digital life years ago.”

“More worrying, in our team conversations were stories of letters inviting people we know to appointments they simple could reschedule their lives to attend, and in one instance an invitation to an important diagnostic appointment on the date the letter was posted.”

“The shift away from fax and paper communication is long overdue. Other health systems have overcome issues of privacy, user engagement etc through the use of protected portals, where the user receives a short message via SMS or similar advising them to log on. Similarly the ability to designate a ‘proxy’ (close relative or friend) to access the portal for those who cannot or do not want to use this sort of tech has been used with good effect in other parts of the World. The sooner the better we say…”

Dr Damien Marmion, CEO at Ingenica Solutions

“As part of the NHS tech transformation a move from old paper-based processes is essential.  As Matt Hancock stated he wants all NHS staff to use email to communicate with patients rather than sending letters in the post. For Ingenica Solutions this is an ethos we support, not only for communication with patients, but also across departments within the NHS.  Our implementations have led to successful process improvements including the reduction in paper between procurement, clinical and finance areas.  For instance, we have ensured that ordering to receipt is now fully electronic in some of the hospitals we work with and consumables / prosthesis are now recorded electronically to the patient record rather than using paper records.”

“While the NHS app should manage some of these concerns with its validation process, further clarity and guidance on the above, including sharing of information, may help to further reassure practices and hospitals wanting to use email as a form of communication with patients.”

Marc Warburton, Chief Executive, InfoFlex

“The use of faxes in the NHS must be stopped as soon as possible. Modern communication channels, such as emails and messaging between healthcare systems, provide highly secure ways of sending information within the NHS and care organisations.  However, relying solely on emails and texts to communicate with patients is not full-proof – not all patients will have access to the required technology. The preferred method of communication should be the patient’s choice, with emailing and texting being promoted as the best way.”

Ian Chuang, Chief Medical Officer, EMEALAAP Health, Elsevier

“The commitment to the use of email in place of paper is long overdue.  This move to digital communications must be part of the  larger digital transformation programme designed to enable better data sharing between patients and all of the healthcare professionals caring for them, irrespective of their location in a health economy.  This digital communication is a necessary step towards a broader strategy of patient engagement and patient participation in their care process facilitated through what becomes truly digital collaboration.”

“It represents a key foundational piece of work for the downstream development of deep analytics needed to release the potential of real-world evidence derived from large patient datasets, and subsequent feedback loops into the clinical knowledge base that continually reflects current evidence-based medicine (EBM) from research literature and sources of practice expertise.”

“As part of the shift from paper to email, it is of course essential that this is underpinned by a robust digital inclusion strategy.  Those patients who do not have ready access to the internet or have lower levels of digital literacy must not be left behind on this journey.”

Guy Wood-Gush, CEO, Deontics

“This is only moving NHS communication into line with mainstream activities in the outside world and can be much more efficient for patients and clinicians alike. However, given the nature of the situation where the greatest burden of ill health falls on the elderly, it will be important to retain sufficient of traditional methods of communication for those patients who don’t have access to email.”

Mark Smith, Business Development Director in the UK for Enovacom

“Enovacom supports Matt Hancock’s statement that email should definitely replace paper, but remembering never losing sight of the importance of security of those electronic communication transactions, something that we take very seriously and should be part of any interoperability solution offered by a vendor. Enovacom has actively supported healthcare organisations, at either end of the digital maturity index scale, to deliver their digital transformation objectives, recognising that the pace of change is not a generic “one way fits all” solution for health customers.”