As my sons sit at the dinner table texting on their phones, it got me thinking about how we physicians communicate, and how that has changed over the years.

When I started in residency, fax machines, phones, and regular email were the choices for communication – in addition to face-to-face, of course. There are a lot more options today.

With those options come a more complex world with HIPAA rules and more complexity in the data that needs to be transmitted. Films are no longer carried from place to place by patients. Images can be sent in seconds.

It’s no longer a simple document. We’re now asked to quickly and securely transfer images like EKGs, MRIs, other scanned images, and more.

There are privacy issues. The second barrier is time. The urgency of the communication may dictate what method we use. Here are five methods from most urgent to least urgent:

1. Phone

Cell phones have made phone usage more convenient. If we have an urgent problem, and need to securely communicate, pick up the phone and call.

Assuming both parties are available and it’s very urgent, that’s still the best way. There are potential delays, and people and answering services or messages that have to be left, but nothing satisfies the truly urgent need like a phone call.

Phone is a push method for exchanging information, that is, we are pushing data out (reaching out with our voice) to reach someone. We’ll discuss the “pull” method below.

2. Secure Text Messaging

Those smart phones also have text messaging and email capabilities.

Is that OK? In short, no, because you run the risk of getting in trouble with the HIPAA rules. Neither regular text messaging nor normal e-mail are considered secure methods of communicating secure Personal Health Information (PHI).

Can you send a text message or email asking for a call? Yes, but there are better ways.

Secure text messaging technology does exist that satisfies the security needs, and is also able to give you a read receipt, and even a notice that your message hasn’t been read within a set time period. There may be a price, as these services are not normally built into your cell phone bundle. Assuming you have your colleague’s cell phone number, and/or they subscribe to the same secure technology, you can securely text.

One example of a secure text messaging service is Amcom. Advantages include the ability to attach other data to text messages, but that capability may not always be available.

3. Secure messaging systems or apps

There are a few health systems that are doing this for their providers. So do DocBookMD, a mobile app that some of our county medical societies in Pennsylvania are using, and Doximity, an online professional networking tool.

This, too, is a push system, since you’re pushing an outreach to your colleague, and asking for a push (of data or an answer) back. Messaging can be very timely, and doesn’t require interrupting what you’re doing to go to a phone, but you can answer at your convenience.

4. Secure email

Secure email does exist, and is being used in multiple places across the country, including here in Pennsylvania using a nationally set group of standards called DIRECT. This is also an optional service, requiring physicians and other providers to have a DIRECT address.

This is also a push method (of sending a message out). Email, while allowing receipts, doesn’t have the urgency of a text message. So it works for information that can wait until the receiver has the opportunity to get their email.

5. Health Information Exchange

Finally, there is the Health Information Exchange (HIE) in development here in Pennsylvania. If you join Pennsylvania’s HIE, you can pull (reach out and receive information) on a patient you’re about to see or who has been seen by another physician who has joined the network without any action from the people with the information.

If you have an electronic medical record, your patients’ data will also be available to others. How nice would it be to receive information of all kinds from all the other providers in the state (or eventually country) who have seen your patient?

What method should you use? They each have their advantages, and the overriding issue is the urgency of the need to communicate and what information you need. Ordinary text messaging and e-mail aren’t safe, nor HIPAA compliant, so be careful.