Using HIPAA compliant email to prepare patients for surgery

Surgical procedures require careful preparation to ensure patient safety, reduce anxiety, and optimize recovery outcomes. 

A 2020 study in the Cureus Journal states, “Effective and clear communication is essential to provide the best care possible for patients.” Strong and clear communication directly impacts patient safety, compliance, and overall experience.

Using HIPAA compliant email offers a secure and efficient way to provide patients with necessary preoperative information while ensuring their protected health information (PHI) remains confidential. 

The importance of secure preoperative communication

A well-informed patient is more likely to have a smooth surgical experience with fewer complications than patients who have experienced communication lapses. A study published in the Annals of the Royal College of Surgeons of England assessed the effect of preoperative education on the length of hospital stay after knee joint arthroplasty. The findings indicated that patients who received preoperative education had a significantly reduced hospital stay, averaging 5 days compared to 7 days for those who did not receive the education. 

Preoperative emails can include:

• Fasting guidelines
• Medication adjustments
• Arrival instructions
• Required documents (insurance, ID, consent forms)
• Pre-surgery tests (bloodwork, imaging, etc.)
• Post-surgery care and recovery guidelines

However, since these communications often contain PHI, they must adhere to HIPAA regulations to prevent unauthorized access and potential data breaches. Non-compliant emails can lead to severe consequences, including legal penalties and loss of patient trust.

What makes an email HIPAA compliant?

HIPAA compliant emails must include several security features to ensure data integrity and confidentiality. These include:

• Encryption: The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) has proposed some changes to the HIPAA Security Rule, including requiring healthcare providers and their business associates to implement encryption as a security measure. Therefore, all emails containing PHI should be encrypted during transmission and at rest, preventing unauthorized access if intercepted.
• Multi-factor authentication (MFA): Furthermore, the changes to the HIPAA Security Rule include mandating multi-factor authentication (MFA) as a security measure. MFA adds an extra layer of security by requiring an additional verification step beyond just a password, such as a one-time passcode sent via SMS.
• Access controls: Part of HIPAA’s Security Rule Technical safeguards is the implementation of access controls which “provide[s] users with rights and/or privileges to access and perform functions using information systems, applications, programs, or files.” Access controls ensure that only authorized personnel should have access to sensitive emails, reducing the risk of internal data breaches.
• Audit logs and tracking: According to The Health Insurance Portability and Accountability Act (HIPAA), covered entities and their business associates must “Implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information.” 
• Secure email providers: "The Privacy Rule allows covered health care providers to communicate electronically, such as through email, with their patients, provided they apply reasonable safeguards when doing so." The use of secure email providers, like Paubox, ensures that patient information is protected and received by the intended recipient. 

Best practices for using HIPAA compliant email in surgical preparation

To ensure both compliance and effectiveness, healthcare providers should follow these best practices when using HIPAA compliant email for preoperative communication:

• Obtain patient consent: Before sending emails containing PHI, obtain written consent from patients acknowledging that they understand the risks and agree to receive digital communication.
• Use clear and concise language: Emails should be easy to understand, avoiding complex medical jargon. Provide information in a structured format with bullet points and checklists for clarity.
• Provide essential preoperative information: Each email should contain:
  • Pre-surgery instructions: Fasting guidelines, medications to take or avoid, and bathing instructions.
  • Arrival details: Exact location, parking information, and check-in procedures.
  • Required documentation: Insurance details, ID, and consent forms.
  • Recovery expectations: Post-surgery care, pain management tips, and follow-up appointments.
• Use automated reminders: Sending automated reminders 24-48 hours before surgery helps reinforce important instructions and reduces the risk of cancellations or delays due to patient misunderstandings. For instance, a performance improvement project at Stony Brook University Medical Center's Ambulatory Surgery Center reduced day-of-surgery cancellations from 8% to fewer than 3% by enhancing preoperative communication. 
• Offer secure alternative communication methods: If a patient is uncomfortable receiving PHI via email, provide options such as HIPAA compliant texting, or phone consultations.

Alternative secure communication methods

​HIPAA compliant texting serves as an effective alternative to email for preoperative communication, offering immediate and secure delivery of essential information directly to patients' mobile devices. Paubox Texting, for instance, enables healthcare providers to send personalized, encrypted messages without requiring patients to download additional applications or navigate passcode-protected portals. This method not only enhances patient engagement but also improves operational efficiency. Research by Rebecca Guy from The Kirby Institute has shown that implementing SMS reminders can increase the likelihood of patients attending clinic appointments. These findings support the effectiveness of text message reminders in enhancing patient attendance and improving overall healthcare service delivery. By using HIPAA compliant texting platforms like Paubox Texting, healthcare providers can ensure the confidentiality of protected health information while fostering better patient-provider communication.

​Similarly, phone calls are a valuable alternative to HIPAA compliant emails for preoperative communication, offering direct, personalized interactions that can address patient concerns in real-time. A study conducted at the University of North Carolina Health Care ambulatory surgical center demonstrated that implementing nurse-to-patient telephone calls three days before surgery led to a 53% reduction in daily cancellation rates. These calls allowed nurses to convey essential preoperative information, clarify instructions, and alleviate patient anxieties, thereby enhancing overall preparedness and reducing the likelihood of day-of-surgery cancellations. This approach both improves patient satisfaction and optimizes operating room utilization and efficiency.

Read also: Choosing a communication platform for patients

Tracking and measuring the effectiveness of preoperative email communication

To ensure that preoperative email communication is as effective as possible, healthcare providers must track and measure its impact. Monitoring the outcomes of preoperative emails can help identify areas for improvement and ensure that patients receive the necessary information in a timely and understandable manner.

Key metrics to track

• Open rates: Measure the percentage of patients who open the preoperative emails. According to HubSpot email open rates for healthcare-related emails is 41.23%. This can be used as an indicator for the effectiveness of your subject line, timing, and overall email strategy.
• Click-through rates (CTR): If the emails contain links to documents or additional resources, tracking the click-through rates will provide insight into how many patients engage with the content. Low CTRs could suggest that the email content isn’t compelling enough or that patients are not finding the information easily.
• Patient compliance: Track whether patients follow the instructions provided in the emails, such as completing necessary forms, attending scheduled appointments, or following pre-surgery guidelines (such as fasting and medication adjustments). 
• Patient feedback: Requesting feedback from patients about the clarity and helpfulness of the email communication can provide direct insights into how effective the emails are.

Benefits of using HIPAA compliant email for surgical preparation

• Enhanced patient compliance: Patients receive clear, written instructions they can refer to at any time.
• Reduced cancellations and delays: Automated reminders help ensure patients arrive on time and follow preoperative guidelines.
• Improved patient experience: Digital communication offers convenience, helping patients feel more prepared and confident before surgery.

FAQS

Are HIPAA compliant emails mandatory for all preoperative communication?

While not mandatory, HIPAA compliant emails are recommended to ensure patient data security and compliance with regulations.

Can patients opt out of receiving preoperative emails?

Yes, patients can opt out, but alternative secure communication methods should be provided to ensure they receive critical preoperative instructions.

Can HIPAA compliant emails include attachments such as preoperative forms?

Yes, but all attachments containing PHI should be encrypted to prevent unauthorized access.

What should I do if a patient does not have access to email?

Alternative HIPAA compliant communication methods, such as secure text messaging or phone calls, should be used to ensure they receive critical information.