The answer to the problem is simple.  Ask yourself how the situation worked
in the olden times of paper records & snailmail.  Receptionists opens mail.
If a Dr. ill, away etc, the other Dr's can look at mail of this Dr.  If
envelope marked confidential, then receptionist doesn't open mail, but hands
it to  Dr. concerned.  If he / she away, it is given to another Dr. who
decides whether to open it or not.

Now simply apply it to electronic correspondence

I have a separate E-mail address for correspondence, etc.  Link it to your
"Location Certificate" if you use PKI keys from HIC.  All incoming E-mails
whether encrypted or not goes to this Inbox.  Reception has access to this
as all the GP's, depending on what the Dr's desire..  If Dr away, his
E-mails can still be read and acted on.  If a specialist wants to send a
confidential letter that no other GP must see, this specialist must phone
the practice to get a private E-mail address linked to "individual keys".
If receptionist tells specialist that Dr Bloggs is away sick, on holiday
etc, the specialist knows that if there is something important to act on, he
must do it himself.

Cedric



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-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Oliver
Sent: Wednesday, 31 May 2006 11:43 AM
To: [email protected]
Subject: [GPCG_TALK] Monitoring incoming emails of absent doctors
andpractice staff


Dear colleagues,

Medical practices increasingly are using electronic clinical systems and
email as their primary methods of communicating clinical information.
Electronic communication has many advantages which I don't need to outline
to the people on this list.

Recently I have become more conscious of the potential risk of important or
urgent clinical information not being acted upon because the message was
sent to either to the clinical inbox or email address of a doctor or other
practice member who was absent, for example away sick, at a meeting or
conference, on holiday, unexpectedly dead or otherwise indisposed.

I am interested to know how other practices make sure that somebody checks
the clinical inbox and the emails of any doctor or other clinical staff
member who is away, in case there are any urgent and/or important messages
about patients that need to be acted upon.

Microsoft Outlook has an 'out of office' function that can forward mail to
another person's email address or reply automatically to the sender with an
"I am not here" type message, but it works only if the user who is going to
be away remembers to switch it on.  If the reason that the user is absent
because he or she has suddenly fallen ill or had an accident, it won't have
been switched on and messages will not be forwarded.  I am not aware of any
such facility in any clinical software package.

A possible solution may be to create software that monitors each user's
logging on to the network on the days and at the times that he or she is
expected to do so.  It would not need to monitor specifically logging on to
the email system or to the electronic medical record package.

Essentially the philosophy would be along the lines of: "I expect Dr. Smith
to log on to the network by 9.00 a.m. every morning from Monday to Friday.
If she doesn't log on by 10.00 a.m., I will send an alert message to the
practice manager, and offer to forward to her (the practice manager) copies
of any unread emails and any further incoming messages for Dr. Smith until
Dr. Smith does log on".

If 10.00 a.m. arrives and Dr. Smith hasn't logged on, and the monitoring
software starts forwarding Dr. Smith's emails to the practice manager, but
the practice manager knows that Dr. Smith will be in a bit later than usual
today for some reason, she (the practice manager) can  just keep an eye on
what is coming in for Dr. Smith without doing anything about it, because she
knows that Dr. Smith will be there soon and read her own emails.  Once the
practice manager knows that Dr. Smith has logged on, the practice manager
can delete Dr. Smith's forwarded emails. The monitoring software could even
notify the practice manager once Dr. Smith has logged on.  

On the other hand, if the monitoring software has sprung into action and
started forwarding Dr. Smith's emails because Dr. Smith has had an accident
and won't be in today or possibly for some days or weeks, the practice
manager knows that she will have to take appropriate action about any of Dr.
Smith's incoming messages that need to be acted upon. She may, for example,
either contact the senders with the bad news about Dr. Smith, or refer the
messages to another doctor in the practice for action.  Once Dr. Smith has
recovered and comes back to work and logs on, or logs on from home or
hospital, the monitoring software would detect this and automatically stop
forwarding her emails to the practice manager.  However, if 25 hours elapses
before Dr. Smith logs on again, perhaps because she has relapsed, the
monitoring software will detect this and again notify the practice manager
and offer to start forwarding Dr. Smith's emails to her once more.

The monitoring software has nothing to do specifically with any specific
email package or with any clinical package, since it would monitor only the
users' logging on to the network on expected days and times.  It could be
used in any organisation, not just medical practices, where important and/or
urgent messages may be sent to people who may be absent, and others in the
organisation need to be notified of such messages.  Such monitoring software
could useful in a wide range of organisations.  

I would be pleased to hear what others think of this suggestion.


Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens
South Australia 5086
Ph. 08 8261 1355  Fax 08 8266 5149
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