Why can’t you email your doctor?

Email may be the preferred communication method with clients in many industries, but many health care clinics are still relying on phone and fax to connect with patients. Only about 11% of Canadian primary care doctors communicate with their patients through email. In comparison, 35% of doctors email patients in the United States and United Kingdom, and in Switzerland, 68% communicate electronically with patients. Some countries, such as Denmark, even have national mandates that all individuals have the ability to email their primary care physician.

Currently, the regulations and professional recommendations around email communications are contradictory. On top of this, secured email software is expensive and difficult to implement. As a result, many doctors and patients are left emailing over unsecured platforms — with little legal guidance — or simply not emailing at all.

Email has “potential to improve patient care”

One of the advantages of email is that it can allow for “more efficient communication,” says Patrick Ceresia of the Canadian Medical Protection Agency (CMPA), the organization that helps Canadian doctors with legal protection costs and provides legal advice. With the right software, emails can also be archived and stored as part of a patient’s medical record, saving clinicians from having to document their telephone conversations.

Patients and caregivers are interested in communicating with their doctors over email. For some patients who frequently change phone numbers or mailing addresses, email may be the most reliable option, while others simply prefer to communicate electronically rather than through phone or face to face appointments. Furthermore, studies have shown that some patients are more likely to communicate sensitive health-related information to their clinicians over email than by phone or in person.

“Emails have the potential to improve the quality of patient care,” says Sabrina Sullivan, a patient in Calgary who has used email to communicate with her doctor. Sullivan says emailing lets her take an active role in her health care and build rapport with her doctor. Doreen Rabi, an endocrinologist at the University of Calgary and a researcher in this field, agrees that email makes it easier for her patients to “check in” with their medical team about simple questions. And email communication may help fill a gap for the 37% of older adults with chronic conditions in Ontario who are not able to easily contact their health care team between appointments.

It is not yet clear from the evidence, however, whether email is superior to more traditional communication methods. A Cochrane systematic review of studies evaluating email for clinical communication noted that the evidence to date contains “variable results and missing data,” and that a clear conclusion about the clinical value of email communication could not be reached with the evidence to date.

Privacy concerns

While email communication has a number of potential advantages, the ability to maintain patient privacy remains a fundamental concern, says Donna Call, senior communications advisor at the College of Physicians and Surgeons of Alberta (CPSA). And this concern is not limited to Alberta. In Canada, health information custodians, such as hospitals and clinicians, are responsible for ensuring the secure transfer of personal health information.

In Alberta, the Privacy Commissioner’s Office (PCO) recommends that all email communication take place within an encrypted and secure portal. However, the personal email services most often used, such as Gmail, do not meet these security standards, because they are not encrypted and do not communicate through a secure portal.

While it recommends secured, encrypted communication, the Alberta PCO does allow for the use of unsecure channels in circumstances where only limited personal health information will be shared. What constitutes limited data is up to the doctor to assess, states Brian Hamilton, director of compliance and special investigations at the Alberta PCO. Generally, however, it’s acceptable to email information such as clinic announcements, even though the fact that an individual is a patient in a specific clinic is considered personal health information. But it’s generally not acceptable to email details about a patient’s care.

In Ontario, the PCO recommends secure, encrypted email communication but, if that’s not possible, the PCO suggests doctors obtain explicit consent from patients to use unsecure email. Both parties involved need to be aware that there is no fail-safe way to control who has access to information that is shared across unsecured networks, says Debra Grant of Ontario’s PCO.

Grant explains that even if patients send an unsecure email to their doctor directly, consent to this communication cannot be implied. She says that before responding by email, physicians are obligated to discuss the potential risks of email communication with their patients in person or over the phone. Once the patient understands the risks and has provided informed consent, a doctor may communicate with them via email, but should still minimize the amount of personal health information contained in those emails.

Interestingly, in Alberta, patients cannot consent to using unsecure email channels to discuss details about their care, according to Hamilton.

The CMPA’s position on unsecure email has evolved over the past several years and is now similar to Ontario’s PCO recommendations. The CMPA advises doctors to use secure communication methods, but says those who choose to use unsecure email should take steps to minimize the associated risk, such as obtaining patient consent.

Both the CPSA and College of Physicians and Surgeons of Ontario (CPSO), take a firmer stance on this issue. They recommend that doctors only use secure and encrypted emails to communicate with their patients and avoid other unsecure methods of electronic communication altogether.

As a matter of best practice, the CMPA and the Canadian Medical Association (CMA) recommend that doctors get patient consent for email communication, regardless of whether the network used is secure or not. To aid this process, the CMPA has developed template consent forms. In addition, both the CMA and CMPA advise physicians to set expectations about response times and what content is appropriate to discuss over email. Furthermore, doctors are responsible to assess if email is the most appropriate method of providing care to that patient in a given circumstance, according to Andrea Foti, Manager of Policy and Privacy Officer at the CPSO. Patients should also be aware of who will have access to their email, such as receptionists or other medical staff.

Cost and workload concerns

Currently, not all doctors have access to secure portals to communicate with their patients. This is especially true for doctors working outside of hospital settings and in the community. Some provinces, such as Alberta, have begun taking steps to integrate secure electronic communication into their health care system. These programs, however, are in their infancy, according to Ceresia.

Meanwhile, there are private communication companies, such as Wellx, which doctors can use to set up secure email portals. Rajesh Girdhari, a family doctor in Toronto and partner at Wellx says that for most clinical teams such technology works well and improves patient satisfaction.

For some doctors, however, the financial burden and complexity associated with technologies like Wellx’s makes them difficult to implement.

And solutions like these are not always easy for patients. As one patient told us, they often forget their password to their doctor’s secure portal and find the process of using it time consuming, compared to regular email. As a result, some clinicians consciously choose to use unsecure email due to the added efficiency it provides, even though they are aware of the privacy risks associated with its use.

Both patients and doctors also describe concerns regarding the “rules of engagement” for emailing.  In a unpublished recent study, Rabi found that doctors would be more accepting of engaging in email communication with their patients if there were clear guidance about when and where this communication method is appropriate. These concerns are often compounded by the legal implications of providing medical advice over email and the associated increased workload.

The workload concern may be smaller than doctors think, however. Most email requests received by physicians are non-urgent and relate to simple medical questions, following up on medical advice, subspecialist referral information and medical prescription renewal. In fact, one study found that far less than 1% of all emails reviewed required immediate attention. Patients are also mindful of overwhelming doctors with too many or inappropriate emails, says Girdhari. Studies have shown that most emails only address one problem and are used to communicate straightforward information. In some clinical practices, however, the use of email has resulted in increased workload for the health care team, and does not always decrease telephone call volume or doctor visits. However, the results are generally inconclusive across many small studies.

Finally, for a busy clinician, the lack of reimbursement for email communications may serve as a deterrent for its widespread adoption. Currently, only British Columbia has payment for certain specialists who email their patients.

Will Canada’s health system embrace email?

Despite the many perceived barriers associated with email communication, email is already being used by some doctors to communicate with patients and has the potential to transform the way patients receive care. But it remains to be seen whether the system and policymakers support this transition in a manner that protects both patients and their health care teams.

The comments section is closed.

  • Gabriel Lagage says:

    Please consider an article comparing “Virtual health services in Ontario”

    This is a comment on virtual care software providers Novari v Medeo.

    My doctor used Novari a year ago. It worked very well. 2-way conversation. Award winning Canadian company.

    A few months ago the Clinic started using Medeo (the name is just a brand, they have been bought out by QHR’s virtual healthcare)
    The process is a one-way dismal network. Only the clinic can initiate a conversation. The patient is left out in the cold. Phoning into the clinic office and leaving a message adds one more step to the process.
    Why would anyone recommend and use Medeo?

    I think my only recourse is to change family physician of more than 15 years of satisfying relationship.

    Please consider an article comparing “Virtual health services in Ontario”.

  • Bijay says:

    i have some time loose stool and left upper stomach is mildly pain from last 5 years what can i do?

  • Don says:

    Wow, how many of the commenters above actually know what’s involved in the fax process? To believe sending a person an email is more secure than sending that same person a fax is more secure just tells me these posters do not understand what processes are involved for in faxing or in emailing.

  • Jay says:

    I didn’t choose any of the options provided. Because from a patient point of view, all I need is efficiency booking appointments with doctors. However many of the clinic offices phones have no man to pick up your calls. I can only leave a voice message which many times, won’t get me call-backs and I have to call again and repeat this bad communication way.

    So if clinic offices can’t guarantee their phone system to communicate with patients, patients will have to look for other ways to contact them, like through email or in person.

  • Michael Shaw says:

    I have had more faxes and telephone messages intended for someone other than me than errant emails. Even some faxes and telephone messages from doctors’ offices errantly sent to my fax machine or answering machine. It seems to me that email is less likely to be a problem in most circumstances than the alternatives. I would even prefer text messages over phone calls. I don’t recall receiving an errant text message.

  • Rob Williams says:

    I commented on this debate when it first appeared 3 years ago and talked about OTN’s eConsult service. One year ago, OTN initiated an eVisit proof of concept project. More than 100 docs are now involved in our primary care EVisit proof of concept project. It is undertaken in collaboration with several LHINs and the docs are happily and securely messaging with their patients using our vendors of record Novari, QHR or Think Research.

  • Gino says:

    This is a dated article. The point made about non-encryption is NO LONGER THE CASE. Email providers no longer send email out over port 25 – its sent on a secure port – even Gmail. All use some form of SSL encryption.

    The only reason for this is litigious thinking – limit the amount of communication. Put the onus on the patient.

    Ever try and get in touch with a doctor on the phone?

    Fax? Why not Western Union?

    The whole system is a godawful mess.

    Google “unnecessary surgery”.

  • terrei says:

    Many health care provider require patients to fax documents to them. I have not seen many people mentioning that a fax is written data transmitted over a non-encrypted telephone line. Most email providers encrypt emails. What is more secure?

  • Wayne Harvey says:

    I need to communicate with my doctor. DO NOT need a personal visit. Telephone is out of the question because of TWO big things:
    -I need a record of what I said
    – I need a record of what he/she said

    Hey folks there is a way to DO this called email. WHY WILL DOCTORS NOT USE email??

  • Martha Crosby says:

    My doctor uses this great system called They send me messages about appointments and blood tests etc and it’s all secure. I can’t reply back though. I asked my doctor and he told me that he was not paid to answer emails from patients. He said he tried but the burden of work was too much. Apparently he is only paid when he sees a patient. He said if he was salaried he would be happy to answer emails but then he would see less patients. Anyway, Clinicinfo seems like a nice compromise for my doctor as he can send me messages electronically which I find more convenient.

  • roger flanagan says:

    you dont want to know my true comments??

  • roger flanagan says:

    doctors are a total waste of time and money! what i asked for is that i be given the right to die,euthanasia..all they do is stop your tablets and send silly letters .

  • Kathy White says:

    Living in Grande Prairie, Alberta, I have yet to find a doctor that will take appointment even, by email. It would be SO much easier, as I cannot speak. At the doctor where I am at, the office person states she is “too busy”, but will take them by text or fax. What’s the difference? I fax things from my printer for appointments or to add to file. I finally found a pharmacy that will refill by email. My eye doctor communicates by email. Home Care through encrypted portal email.

  • Eric says:

    Health is the biggest disappointment, because they are behind in some levels.
    1. when you see your doctor, or switch doctor and meet another doctor, they each have its own files about you instead of having access to one file globally. All doctors in the same country should all have the same access to the health care patience, only doctors would have such access to these files. Why pay to transfer old files from one doctor to another, when 1 global file can be created.
    2. when waste time in meeting a doctor (travelling, time, gas, time off work) just to speak to a doctor for a few minutes, why can’t doctors setup a web video chat with their patience, a lot more convenient. Sometimes patient have questions, would be nice to email. They don’t have to worry about security if there would be a secure website, where your name, profile information is registered, and by login in, you can email or chat with your doctor.
    3. we don’t even have technology at home, where we can diagnose ourself, kind like a cool device that can scan your arm or leg or head and the machine would analyze and display the results on a screen that looks like an invisible ipad, with graphics and charts and blood levels, etc.. imagine if such technology existed, that means less patient waiting at the hospital (not wasting any time) and only make appointments with doctors or hospital if your health issue is critical and or if you need a prescription.

    Health is too much far behind, when are they going to change and make life easier for everyone. Forget the costs, help others help you and me.

  • Eric says:

    We are in the future, yet the Health System is still old fashion in some ways. Here is some great ideas:
    – client should be able to communication by (video phone, facetime, or regular voice phone) with their doctor. Sometimes the doctor may say, I would like to meet you after a blood test, well if you have to spare some time and drive (could be 30 minute drive), it would save us time and money to just sit at home and speak to the doctor with great communication tools, if you have it than why not? I think if the Doctor place has the tools to do it then let the client decide how to meet with their doctor. If the doctor needs to give the patient a prescription, to simply email an encrypted email to the client or to fax it.
    – Sometimes, the patient may have a few questions about their body, and to make an appointment to meet to talk about something that could have been dealt quicker over the web communication tools, would save the client time (waiting in line), money, etc.
    – I wish people were able to have self health products for home use. It would eliminate long extreme wait time in hospitals and clinics. Like scanning device that checks for broken bones, muscle sprain, etc. and that can detect low blood pressure, cell problems, etc…You see it in sci-fi movies, why not make it a reality?

    • Eric says:

      Also, every should have 1 health profile. Before it was on paper, and when you change doctors, you would have to maybe pay a fee to transfer your existing files to the new doctor, or start fresh with your new doctor. With everything being on the computer these days rather than on paper, shouldn’t there be a secured data center, where all patient info is recorded, and no matter what old or new doctor would have access to your profile and your profile remains up to date all the time, if you can bank online, I am sure the health system can somehow do the same?

      Tools needed:
      1. one on one video chat with your doctor, if its serious you book an appointment, if not, you have your answers instantly without the need to meet in person.
      2. you have access to your profile information, only the doctor can update it, but at least you can be aware of your health history, it would have to be access to a secured website. Just like how people access their tax information via online and or bank online. It can be done.
      3. If you have a problem, or your wondering about that spot on your skin or you have a cold and instead of making an appointment with a doctor and or ask the pharmacist and or google for information, you would have a pod scanner that scans your whole body and information is then transferred to this web data (offline data) that tells you what you have and if its serious to see a doctor. That would probably cost lots to have such device, but would be neat to have and possible save live if it detects a cancer in you.

  • Sarah says:

    I immigrated to Ontario from another country – where email and even text messaging reminders (for appointments, screenings etc) is offered as an alternative communication vessel from my doctors office. As a patient, I find it very frustrating that to provide copies of my medical documentation I need to either provide in-person (waste of time), over the phone (often my doctors office is busy and I have to keep trying) or by fax (which most people do not have in their homes). I understand that some people have security concerns about email however I do not see how email is any more insecure than physical post (that could be intercepted, no tracking of receipt) or fax (printed on receipt for anyone in the medical office to see).
    Enter the 21st century Ontario – embrace the technology and offer another line of communication to your patients.

  • Pierre says:

    My main concern is not issues of security/hacking but rather I have a major issue with google/gmail. In my experience, many BC doctors like to use gmail accounts. It’s widely known that gmail scans every email and builds a profile of you so that it can then sell advertising. Google already knows too much about us, why can’t doctors simple use another email provider – It’s not that hard or expensive, for example search for startmail – fully encrypted, private and costs $60/year.

    • Sarah says:

      Absolutely agree! Email should be offered but with a secure provider with end-to-end encryption. However, if my doctor only offered gmail I would probably still use it!

  • J. Szul says:

    I chose to communicate with my dentist, my oral surgeon and my optometrist by email. ItT is much easier than playing phone tag. The issues discussed are not that private that I would be embarrassed if misdirected. Furthermore, I am prepared to take that chance. Finally I am not sure it is at less risk of breach of privacy than a misdialed fax number or letter delivered to my neighbour’s house instead of mine. Frankly that happens more than having my emails misdirected (or hacked, I suspect). Thank you. J. Szul

  • Roy Snell says:

    The greatest security issue related to e-mailing confidential health information is not the protection of that data during transmission or storage on a mail server. These two issues can be handled well by using a secure connection to a mail server that encrypts the stored data.

    The real problem is that access to the mail accounts of both the sender and recipient is typically protected by nothing more than a username and password. The username is often publicly known or very predictable. So the security of the information comes down to a password which, for most users, is simple or predictable ( so it’s easy to remember – a spouse or child’s name or the name of their pet) or can be obtained by “social engineering” interactions with the account owner via phone, e-mail or web access. That means that your account and confidential data can be “attacked” anonymously from anywhere in the world without your knowledge.

    Contrast the above scenario with the situation where the information is transmitted by voice, fax or regular mail and exists only as a printed or handwritten document on the premises of the medical.
    professional or patient.

    If you don’t have any concerns about third parties gaining access to any of your medical information then e-mail communication will be your best option. If you are worried about information about a serious medical problem being sold by hackers to insurance companies or financial institutions then don’t use e-mail. Make the choice that best suits your situation.

  • Trish Cocksedge says:

    My husband was informed that he had a follow-up visit with a neurologist in Victoria, B.C. Now, we live in Powell River B.C, which means that we have to take a 1 1/2 hour ferry to Comox then drive approx 4 hours to Victoria to consult. The return ferry costs are covered by the Health Authority, but nothing else. We have to pay for gas and it takes a full day, leaving at 8:00am and arriving home at 9:00pm. For seniors, this can be stressful, costly and, unfortunately, not always useful. The neurologist told my husband that he could not find the issue for increasing loss of mobility on his left side. So, why go?? What about a phone call or an email or a consultation with his doctor here?? The costs for our health service (ferry, physician) are high when so many people are making this trip on a daily basis to Vancouver Island, be it Comox, Campbell River or Victoria. If you have to stay overnight because of timing of the appointment, you cover those costs as well, although once you have built up a pile of bills, you can subtract from your income tax, but it does not serve those who only go a few times a year. This is hugely costly all around, hugely stressful, and in our case a huge waste of time and money! I wish that someone would look into these needless costs. And, I often wonder if the reason you have to go to the office is that the specialist claims more than for a telephone call or email.

    Thank you

    • Gerry Goldlist says:

      “And, I often wonder if the reason you have to go to the office is that the specialist claims more than for a telephone call or email.”

      The doctor claims NOTHING for a telephone call or email.

      I asked my doctor’s secretary to ask the doctor bill me directly for a phone call with results. I wanted to save canceling patients in MY office, gas, parking and my time. The secretary wouldn’t do it.

      I do not make my patients come back purely for results but absorb the secretary cost myself. If a patient calls me, I bill for the call.

      Logistically, it may be a problem for many doctors to offer this option but it certainly would have saved you a lot of time aggravation and even money. As the government cannot afford to pay for more healthcare services, the option for the patient to pay for non-office care would be a great advantage for many people.

  • S. Ross says:

    Privacy should be of the upmost importance for quality patient care.

    • Trevor Pugh says:

      I am a patient who rarely has need to visit a doctor’s office. Recently I was alarmed to see a notice on the office wall stating that my appointment will be limited to a maximum of ten minutes and should only include one ailment. A week later I needed a follow-up appointment to discuss my lab-test results. I knew this would take a while so I phoned ahead to see if I could send an email listing answers to all the questions I anticipated might be asked. The answer was no. I explained my rationale but was told to bring the list with me.
      I see no security concerns because I am not asking for a response, I am simply trying to save precious office time, and give the doctor a heads up about my condition.
      This is an efficient use of email, especially if it was sent as ‘Do Not Reply’.

  • Rob Williams says:

    I agree with the remarks and observations made in the article. Email can be used to address administrative issues and simple non-urgent questions, but beyond this, a secure platform should be used for transmitting any sensitive/private health information. Whether using email and/or a secure platform, integration with electronic medical records would be ideal for the patient and provider.

    One item that wasn’t addressed in the article is provider-to-provider collaboration/consultation concerning a specific patient over secure platforms, like OTN’s eConsult – a secure electronic exchange service between providers. This can often avoid the need for an in person consultation and can greatly improve the care of a patient as they progress through the system and transition between different care providers.

    Eventually, healthcare, like so many other industries, will be able to offer efficient, easy, and secure solutions to patients – it’s only a matter of time.

    (Disclaimer; I am the CMO of Ontario Telemedicine Network)

  • Aaron Terry says:

    Emails stored on external servers are not secure unless encrypted at source. Binfer is a great way to send secure email. It does not store emails anywhere so is very secure. The link is

  • Aurelia Cotta says:

    I am assuming that all of you are aware that any Blackberry (BIS, individual server) is the most secure system in the world. Using your ISP’s provided email address (eg. or Bell, or Telus and clicking the encryption button in settings to “on” and no one on the planet can hack in.

    I know, you all want shiny, pretty, zero security iPhones. Even though IOS doesn’t have enough security for a patient portal, much less email.

    IT staff keep telling you. But you don’t believe them. Sigh.
    As for Privacy? The Ontario Commissioner ruled long ago that paper mail and faxing have no security, but email is very secure if you password protect attachments, or emails themselves, and send the password separately, or verbally convey it on a visit.

    Oh, and if you want to use your own domain, just have your website/email hosted through servers running 128 bit encryption, like the ones owned by large companies, who then charge a small fee/month. (eg. Don’t host the server in your basement)

    Stop making this so complicated. Email isn’t brain surgery!

    Simple, cheap and in my case, lifesaving when my family doc replied by email one saturday night at midnight.

  • Gerry Goldlist says:

    Re “Interesting idea. As the article pounts out though, many of the emails that would be sent to family doctors would be non-urgent and likely asking for a diagnosis or “quick opinion” that fraught with medical-legal complications.”

    Not sure if you are implying that “non-urgent” and “asking for a quick diagnosis” are not valued enough to pay the doctor for.

  • Name (required) says:

    Interesting idea. As the article pounts out though, many of the emails that would be sent to family doctors would be non-urgent and likely asking for a diagnosis or “quick opinion” that fraught with medical-legal complications.

    Email could, however, be an integral tool in solving one of the biggest gaps in current care: communication. Many patients leave offices having not fully understood the counselling the have received (regardless of the quality). Pamphlets still priloferate but are often lost of not adequate. Using email as a form of automated follow up with patients would close many – not all – of these goals and greatly reduce unnecessary visits both to hospitals and family practice clinics.

    Like many digital assets (apps, social media), the use for communication technologies like email is poorly understood. Security is no longer an issue – tech companies have figured this out and the current systems are excellent. The greater issue lies in understanding the full potential of communication technologies, and – as one post points out nicely – the physician community accepting that leveraging external expertise is a million times better than “doing it myself”.

    Dave Coughlan
    ICI Medical Communications

  • Gerry Goldlist says:

    With regard to non-capitated practices, there is an obvious solution for costs and time spent on emails. Just as many physicians charge for phone calls, they could just as easily charge for email care. This would save the patients time. Avoiding time off work would also save many patients money.

  • Sandi says:

    With one exception, all of my doctors are very receptive to email communications. I am entirely thankful for those progressive healthcare professionals (and their staff) who make my life so much easier. Sunnybrook-Odette has which is an exceptional source of information for patients, families and other healthcare providers not on the MyChart system. As a patient, I value not only my own time but that of others. Email/online patient access tools is much more efficient than the dinosaur systems of fax machines – I haven’t owned a fax machine in over a decade! I agree with others that privacy is not a major concern for most/many – what exactly is someone going to do with a copy of my MRI? Obviously in person/phone is preferable in selected situations, but, really? A phone call or appointment just to receive a copy of a report? Social media and the vast majority of patients are ahead of our healthcare systems in this regard and have been for a long time. Be warned that the younger generations require more uptake given their wide adoption of cyberspace – from birth onwards. Hopefully we can move fast forward on this for the benefit of everyone (or most).

  • Darren Larsen says:

    There are a handful of excellent secure patient email platforms in Ontario which are not expensive at all. I switched from regular email to one of these two years ago, and patient feedback on the service has been fantastic. I have to say this service is never abused by patients, and in a busy comprehensive practice I get 6 – 8 emails per day from patients, and all of these would have been telephone calls if not handled this way. Email has the convenience of being able to be answered when it is convenient for me rather than when the phone rings, so is much less of an intrusion into natural work flow. Our secure email system even integrates seamlessly into our EMR for outbound messages, although inbound need to be copied and pasted into the chart (this is an EMR vendor issue which could easily be fixed!!). Working in a capitated payment model makes it easy to fit this line of work into one’s day, where the most appropriate care can be offered to the need of the patient at that time, and where not every problem or question requires a visit in order to be paid.

    Even before we had secure email, our office used regular email with consent. We took the CMPA Email consent form and built it into our office web site. To consent, patients were directed there, read through the consent, clicked “I accept” and added their name and birthdate into the form and this was automatically forwarded to our secretary to record in the demographics comments field of the EMR. This way all knew who could be safely emailed and who could not. This system worked really really well!

    Personally , I can’t wait until the use of email becomes the norm in our cadre of patient care tools, not to replace every visit, but for routine issues that can be handled simply this way. In truly patient centred care this is an excellent tool. And then we would no longer as a profession single handedly be keeping the faxing industry alive (and we all know how secure those are!!)

  • Lee A. Green MD MPH says:

    Before moving to Alberta 3 years ago, I was one of that large number of US physicians who communicated regularly with patients by email. I did so since the early days of email, so had over 20 years of experience with it. Our whole practice (53 physicians) did so regularly, and the majority of our communications with patients were email (greater than phone and mail combined). We had a secure portal for patients who preferred it but few used it; most were comfortable with regular email. I find the concerns of medical authorities in Canada, and in Alberta especially, quite overblown – bordering on Luddite. Over two decades our practice exchanged hundreds of thousand messages with patients. All the bad things that seem to be feared really don’t happen. The bogeyman is not lurking in cyberspace! It is quite ironic that such concern is raised about email, when we routinely send information by telephone calls, faxes, and post – all of which are much more vulnerable to interception or mistaken delivery than email.

    • Ellison Richmond says:

      Hi Lee,

      I agree with you that many concerns about email are overblown, and that there is often a misunderstanding of relative security risks. However, I believe that we do not need to settle for unsecured emails or text messages – we should expect easy-to-use, inexpensive turnkey solutions which are supported (financially) by authorities. We designed Medeo Secure Messaging because we know that physicians and their patients are using texts and emails to communicate, despite security concerns, because they are expedient ways to keep in touch.

      (Disclosure: I work for QHR Technologies, creators of Medeo)

    • Brian Dazé says:

      Excellent note. And I completely agree.
      In particular, I agree that email is much more secure than phone(you could be speaking with anyone), fax (does this still exist ? Sits there in the tray for anyone to access) and mail (frequently left in a location accessible to anyone).
      Email is at the very least password protected.
      Welcome back to the 1980’s…

  • Ed Weiss says:

    I’m a family doctor in Ontario, and my own family doctor uses the WellX system mentioned in the article. I can’t say enough good things about it from a patient perspective. It’s great for simple questions that don’t require an office visit, and I’ve even been able to send him documents that he would otherwise have to scan, file, etc.

    From the physician’s point of view, I’m certainly in favour of using email to communicate; it’s a vast improvement over playing phone tag, which is annoying and wastes everyone’s time. I will be raising the issue with the other doctors I work with in the near future.

    With regard to cost and reimbursement, I believe this hinges mostly on the payment model a particular doctor works in. Those working on a fee-for-service basis actually have an incentive to get patients to come in for in-person visits (otherwise they don’t get paid). That itself might be an obstacle against adopting email communication, rather than the lack of reimbursement per se. As for me, I work in a capitated model, and if I’m able to communicate information by email that otherwise would have required a clinic visit, I will certainly do so, since the financial impact is minimal, and I would much rather use that time to see patients or get other work done.

    I hope we’ll be able to make progress with regard to implementing email communication on a broader scale sooner rather than later!

    • Michael C Cox BSc PhD CChem FRSC. says:

      I taught chemistry in the UK and being paid on a fee-for-service basis never crossed my mind. How sad that some doctors are so reimbursed. It further saddens me (as a Canadian as well as a Brit) to think that, for example, my pharmacy cannot request a repeat prescription on my behalf but that I must visit the doctor personally for the repeat. Far too much weight is being given to the need for the confidentiality and security of a patient’s records.
      An administrator (in a hospital I must attend soon for the annual check-up on my heart and my implanted biventricular defirbillator) has been discouraged to communicate with me by email by the healthy authority’s security and confidentiality policy. When I try to confirm (at their request) that I shall attend at the scheduled date, time and place, everyone is either away from their desk or on the other line!
      My students were my first concern, not my salary – considerably smaller than the average income of Canadian doctors. Should not their patients be the first concern of doctors?

  • Donna Thomson says:

    As far as I am aware, Tyze Personal Networks (owned and operated by Saint Elizabeth Healthcare) is the only online tool that has the data security enabling a circle of care that includes patient and family in a closed communication web portal. We communicate with our GP regarding our son’s care (he has severe disabilities and is medically complex) using Tyze. We use the site to store all his medical records, keep a calendar of appointments and update on observations as well as requests for support using the ‘Carewall’. It’s a great tool and our GP relies on it, as do we.

  • Mike Carter says:

    I am rostered with my GP, and because the payment scheme is capitated, he is quite prompt at responding to email. I have used it a few times to request a referral or to inquire about whether an office visit is necessary. We do not really share any sensitive PHI. I do not see the need for a secure web portal for most communication.

  • Scott Wooder says:

    I’m a Family Physician and I would love to communicate by e-mail with patients. I don’t know how.

    I’m concerned about privacy, consent and cost.

    This should be regarded as a public utility. We shouldn’t expect thousands of providers to figure it out on their own. We need a turn key utility if we want this to be widely adopted in an acceptable manner

    • Ellison Richmond says:

      Thank you for this article. Scott, for $14/mo you can use Medeo Secure Messaging, designed to look and feel like simple email inbox, but with security and privacy as keystones.

      Medeo is readily available on any computer (via browser) or Android or iOS device, and can be ready to use within minutes.

      (Disclosure: I work for QHR Technologies, creators of Medeo)

    • Brady Bouchard says:

      I agree with you Scott. I happen to be a doc with technical skills, so I can build this myself, but I certainly feel your pain (and no doubt most of our colleagues).

      Medeo seems like a reasonable solution, although it would be a huge cost savings for government to offer it – physicians shouldn’t have to pay individually. To exacerbate the issue, no one (outside of Ontario’s capitation model) has any incentive to do it. I only get paid for in-person visits.

      This will hopefully be changing in a few provinces soon, but it’s slow going.


Meera Rayar


Meera Rayar is a clinical fellow in Paediatric Hematology/Oncology at the Hospital for Sick Children and a Masters of Science candidate at the Institute of Health Policy, Management and Evaluation at the University of Toronto.

Joshua Tepper


Joshua Tepper is a family physician and the President and Chief Executive Officer of North York General Hospital. He is also a member of the Healthy Debate editorial board.

Michelle Stasiuk


Wendy Glauser


Wendy is a freelance health and science journalist and a former staff reporter with Healthy Debate.

Jeremy Petch


Jeremy is an Assistant Professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation, and has a PhD in Philosophy (Health Policy Ethics) from York University. He is the former managing editor of Healthy Debate and co-founded Faces of Healthcare

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