CEJA Guidelines for Internet Use

E-mail recommendations

1. E-mail correspondence should not be used to establish a patient-physician relationship. Rather, e-mail should supplement other, more personal encounters.

2. When using e-mail communication, physicians hold the same ethical responsibilities to their patients as they do during other encounters. Whenever communicating medical information, physicians must present the information in a manner that meets professional standards. To this end, specialty societies should provide specific guidance as the appropriateness of offering specialty care or advice through e-mail communication.

3. Physicians should engage in e-mail communication with proper notification of e-mail’s inherent limitations. Such notice should include information regarding potential breaches of privacy and confidentiality, difficulties in validating the identity of the parties, and delays in responses. Patients should have the opportunity to accept these limitations prior to the communication of privileged information. Disclaimers alone cannot absolve physicians of the ethical responsibility to protect patients’ interests.

4. Proper notification of e-mail’s inherent limitations can be communicated during a prior patient encounter or in the initial e-mail communication with a patient. This is similar to checking with a patient about the privacy or security of a particular fax machine prior to faxing sensitive medical information. If a patient initiates e-mail communication, the physician’s initial response should include information regarding the limitations of e-mail and ask for the patient’s consent to continue the e-mail conversation. Medical advice or information specific to the patient’s condition should not be transmitted prior to obtaining the patient’s authorization.

Guidelines for health web sites

1. Physicians responsible for the health-related content of an on-line site should ensure that the

information is accurate, timely, reliable, and scientifically sound, and includes appropriate scientific references.

2. The provision of diagnostic or therapeutic services through interactive on-line sites, including advice to on-line users with whom the physician does not have a pre-existing relationship or the use of decision-support programs that generate personalized information directly transmitted to users, should be consistent with general and specialty-specific standards. General standards include truthfulness, protection of privacy, principles of informed consent, and disclosures such as limitations inherent in the technology.

3. When participating in interactive on-line sites that offer e-mail communication, physicians should follow guidelines established in Opinion 5.026, "Use of Electronic Mail."

4. Physicians who establish or are involved in health-related on-line sites must minimize conflicts of interest and commercial biases. This can be achieved through the development of safeguards regarding funding and advertising that require disclosure and honesty. It also requires that physicians not place commercial interests ahead of patient health; therefore, physicians must not use health-related on-line sites to promote unnecessary services, refer patients to entities in which they have ownership interests, or sell products outside of established ethical guidelines. (See Opinions 2.19, "Unnecessary Services" 8.032, "Conflicts of Interest: Health Facility Ownership by a Physician" 8.062, "Sale of Non-Health-Related Goods from Physicians’ Offices" and 8.063, "Sale of Health-Related Products from Physicians’ Offices.") Promotional claims on on-line sites must conform to Opinion 5.02, "Advertising and Publicity."

5. Physicians who establish or are involved in health-related on-line sites that use patient-specific information must provide high-level security protections, as well as privacy and confidentiality safeguards.