Secure Messaging

Last Updated: April 15, 2024

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This resource is intended to help Ontario clinicians understand: 

  • How and when patient-to-clinician secure messaging can support clinical practice. 
  • Whether implementation of secure messaging may be beneficial to your practice. 

What is secure messaging?

Secure messaging can enable one-way or two-way communication between patients and clinicians by exchanging messages in a private and secure manner that protects personal health information. The messages exchanged are text-based and can also contain attachments like documents, images, audio or video recordings. 

Patient-to-physician Secure Messaging Proof-of-Concept (PoC) Pilot
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Patient-to-physician Secure Messaging Proof-of-Concept (PoC) Pilot, which will run from April 1, 2024, to March 31, 2026

Ontario physicians who are providing or have significant interest in providing services by secure messaging can register until July 31, 2024. Registered physicians have access to public funding for eligible uninsured secure messaging services and will contribute to the evaluation, informing the overall strategic approach for secure messaging in Ontario.  

More information about the Secure Messaging PoC pilot is available via the Ministry of Health’s INFOBulletin #240103. 

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Secure messaging in clinical practice New

The benefits of implementing secure messaging will depend on an individual practice’s specific resources, roster and workflow. While each practice will have different needs and challenges, various mitigation strategies can be used to suit an individual practice.

Potential time-saving & convenience

  • Reduces the need for some scheduled appointments. Can free up time for urgent appointments. 
  • Reduces time spent on phone calls and paper-based communication. 
  • Clinicians can respond to messages at their convenience. Communication with a patient doesn’t have to happen during a busy workday. 
  • Potential increase in workload when workflows are not carefully considered.
  • Block time in your schedule to address patient messages. 
  • Limit the number of characters or words patients can use to make short, concise requests or comments. 
  • Use standardized templates where appropriate for common message types.7 
  • Triage, when staff support is  available and appropriate, can help route important messages and documents to the right staff member.8
  • Consider inbox efficiency approaches such as:9
    • “One-touch” system – only open a message when you have time to complete a response.  
    • Setting inbox clearing goals to keep message numbers from growing. 
    • Create standard phrases to use within messaging that signal boundaries, such as unavailability during certain hours. For example, end a message with “Just so you know, I won’t be able to access my computer regularly for the remainder of the weekend. If you need anything urgent, please use the main line. Thank you for understanding my absence on the weekend.” 

Promotes privacy & security

  • Ensures confidence in privacy and security standards. The OMA indicates that “the safest way to communicate with patients is through a secure messaging platform. These platforms represent the lowest risk to physicians in terms of susceptibility to privacy beaches and associated financial penalties.”6
  • Reduces the risk of privacy breaches and helps ensure information is sent to the right recipient. For example, in unsecured systems, other individuals may share an email inbox with the patient, or faxes can be accidentally sent to the wrong number.6
  • Selecting and adjusting to a new platform or software.

Facilitates easy information sharing

  • Clinicians can review patients’ questions ahead of a scheduled appointment. 
  • Questionnaires, referrals, prescriptions and other paperwork can be sent to patients before or after an appointment. 
  • Information exchanged is documented and can be saved as part of the health record. 
  • New workflows needed in practices without previous asynchronous communication processes.
  • Consider training clinic/admin staff to delegate and route a common clinic email for message triaging.8
  • For practices where a group inbox management approach is feasible, consider coordinating a physician-to-physician coverage system for physician absences or rotational coverage of secure messaging inboxes.9
  • Change management supports can help facilitate a smoother integration of secure messaging into your practice.5
    • OntarioMD offers change management support to guide physicians in implementing and adopting virtual care platforms. For support with secure messaging adoption, these include:
      • OntarioMD Peer Leaders:A network of 60+ physicians offering mentorship and assistance with digital health technologies.
      • OMD Educates: A series of CME-accredited webinars conducted by OntarioMD Peer Leaders and experts, focused on clinical enhancements using digital health tools. Secure messaging webinars (part 1 and part 2) and associated resources provide support for adopting the application in medical practices.

Enhanced patient engagement

  • Opportunities for communication outside of a scheduled appointment. 
  • Encourages better symptom self-management, as patients can ask questions about medication regimens, side effects, etc. 
  • Increases patient autonomy, empowerment and satisfaction – patients may feel more comfortable asking a sensitive question through messaging. 

 

  • High volume of messages and/or inappropriate use from patients. 
  • Patient access barriers. 

Patient education

  • Communicate to patients about when secure messaging should be used and when it is not appropriate (e.g., send a welcome letter outlining the role of secure messaging).1 
  • Communicate to patients about appropriate use and expectations for secure messaging, including turnaround time, subject lines, etc. (e.g., have patients sign an agreement for use when registering.1 
  • Give patients guidance on how to make the most of their secure messaging encounter. 
  • Add a reminder about expectations of turnaround time and urgent messages to your message signature.9

Patient access

  • Advise patients about the introduction of secure messaging into your practice and include self-registration instructions. 
  • Connect patients with services to support access to training and equipment: 
The role of secure messaging in managing chronic conditions
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The role of secure messaging in managing chronic conditions

  • Opportunities for follow-up and monitoring in chronic conditions such as mental health, diabetes or hypertension.10,11  
  • Useful for reviewing routine information and follow-up for a patient receiving cancer maintenance therapy or surveillance.3,12  
  • It can help with patient navigation, and pretreatment and survivorship visits.3,12
Facilitate clear communication while using secure messaging
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Facilitate clear communication while using secure messaging

  • Avoid multi-part questions and take care to ensure that writing can be understood. 
  • Be aware of the patient’s health literacy.  
  • Avoid acronyms and words that are not suitable for a lay audience. 
  • Consider a back-up plan in case the offered secure messaging option fails. 

Implementing secure messaging in your practice New

Select your platform

  • See Ontario Health’s Verified Solutions List to find secure messaging solutions that meet provincial standards for privacy, security, technology and functionality.
  • Consider both practice and patient needs when choosing a secure messaging platform.
  • Consider if it’s important to have secure messaging integrated with a current clinical information system (e.g., EMR, HIS, etc.). Some systems have existing secure messaging features that can be activated.

Prepare your team

  • Ensure that all team members are consulted and involved including office assistants, nurses and administrators.
  • Dedicate sufficient time for implementation.
  • Consider relevant policies around use of secure messaging such as CPSO Virtual Care, 2022.
  • Plan elements of workflow as a team:1
    • Each practice will have an existing workflow in which to integrate secure messaging.  Consider approaches to using secure messaging that take your practice’s needs into account:
      • Standardize work processes such as patient training and message triage.
        • Who is checking and triaging messages, and how often?
        • How are they sent to the clinician for review?
        • How is a message sent from the office to the patient?
        • What happens if a patient doesn’t read a message? What does follow-up look like?
    • Set up at least one practice inbox.
    • Set up an automatic reply for all clinical messages informing patients when they can expect a response and when to seek urgent care .
    • Set up a dedicated inbox for collecting patient documents, photographs and data. A team member can monitor and add files to the medical record.
    • Ensure all messages and associated attachments are documented in the patient’s medical record. Leveraging a secure messaging platform that is integrated into your clinical information system (e.g., EMR) can help facilitate this. See CPSO’s policy:  Medical Records Documentation, 2020.
  • Establish specific subject lines with key words to help triage and sort messages.
  • Plan how to communicate changes to patients: letters, in-person, email or telephone?
  • Communicate expectations for clinician management of secure messages.
  • For consistency, organize training at the practice level, if possible, instead of leaving it to individual clinicians.
  • Schedule interactive training opportunities to allow care team members to engage with the patient facing side of the platform.

Prepare your patients

  • Confirm tech literacy, access to technology and reliable internet connection.13
  • Identify patients’ preferences for the available secure messaging options.13
  • Ask whether patients are comfortable with secure messaging and in what context.13
  • Ensure patient preference and capacity are documented and accessible to others within the practice (e.g., Medical Office Assistant, other care team members).14
  • In-person and online tutorials may help with patient uptake. Some platforms will offer training as part of their service.13

References