Individual-to-Provider Communication

In this section, we will cover:

According to the OECD study, Towards an Integrated Health Information System in the Netherlands (65), individual-to-provider digital communication (sending messages back and forth digitally) is often one of the first capabilities used in individual engagement. This communication is used in some GDHP countries.

Security and Privacy Considerations

Individual-to-provider communication is sometimes called secure messaging because sensitive health information needs to be securely encrypted when communicated. Secure messaging is often included in a provider-based individual portal. Industry standards for secure encrypted data transmission are important to assure individuals and providers that the message integrity and privacy can be trusted. The GDHP Cyber Security Work Stream developed a Proposed Global Digital Health Model Security Notice (MSN). When finalized, the MSN will serve as an openly available resource to help health technology manufacturers and developers clearly convey information to their customers and users about their product’s security controls. (88)

While security and privacy affect all aspects of digital health, we mention it in this section because individual-to-provider communication may include protected health information that should be treated as sensitive and confidential. We encourage use of industry standards for security and privacy. Some of these standards are used across many industries while others are healthcare specific, such as those described by the Kingdom of Saudi Arabia example. (89)

Kingdom of Saudi Arabia | From Around the Globe

Standards-Based Protections for Security and Privacy

In individual-to-provider communication, the Kingdom of Saudi Arabia recognizes providers may hesitate due to worries about data security and privacy compliance. To address these concerns, the Kingdom of Saudi Arabia lists standards it uses to protect security and privacy:

• OAuth and authorization: obtain individual consent to access records without sharing credentials directly.
• Data encryption and security measures: implement robust encryption and comply with security and privacy standards.
• Individual consent management: manage individual consent for accessing health records from various providers or systems.
• Interoperability standards adherence: comply with HL7® and FHIR® standards for compatibility with healthcare systems.
• User authentication and access control: employ secure authentication methods and access controls for authorized user access.

Why Do Individuals Use Messaging?

Individuals can save time when messaging their providers digitally because they do not need to make a return visit. They may even be more active in managing their health. Some GDHP members use digital messaging for general purposes with guidelines for appropriate use (such as use in urgent or emergency situations). Messaging will look different depending on the software you use, and individuals can send messages and ask questions in their own words for subjects like prescription refills, test results, appointments, referrals, insurance, and general medical questions.

United States of America | From Around the Globe

Secure Messaging Between Individuals and Providers

The ASTP/ONC Patient Engagement Playbook notes, “There are many scenarios in which patients and clinicians need to communicate between visits. Patients may have follow-up questions about a clinician’s guidance or a medication. Clinicians may need to share test results or explain a recommendation in more detail… The portal’s secure email can reduce the need for face-to-face visits and phone calls by giving patients and clinicians a quick, convenient way to exchange information.” (90) The United States of America uses interoperability standards for secure messaging, such as the HL7® FHIR® RESTful API. (91) Other standards used are Applicability Statement for Secure Health Transport v1.2 (Direct™) and Current Procedural Terminology (CPT®) Consumer Friendly Descriptors (CFDs).

Individual-to-provider communication can address health equity. ASTP states, “By increasing our investment in health IT policies and standards, we can help improve the quality of health care delivery and make it easier for individuals and providers to communicate with each other – a huge step toward addressing the persistence of health disparities.” (92)

What are the Barriers to Individual-to-Provider Communication?

It is important to consider barriers for individual-to-provider communications in your country. GDHP members note some barriers may include:

• Triage process (prioritizing and routing messages);
• Fear of adapting to new technology;
• Lack of digital literacy and awareness;
• Concerns about liability and lack of documentation for electronic interactions;
• Impact on provider workflow; and
• Lack of reimbursement.

As Italy notes, even if there are no known barriers, it is important to consider the risks of individual-to-provider messaging.

Italy | From Around the Globe

Watch Out for Underestimated Risks

Italy reports barriers to individual-to-provider communication are not their main concern. Their main concern is risk. Even if there are no known communication barriers, Italy cautions there may be an underestimation of risks related to certain digital tools to communicate/exchange personal health data and documents. For example, there may be inadequate security and privacy precautions.

How Can You Help Underserved Populations in Individual-to-Provider Communication?

Individual-to-provider communication includes more than digital messaging. All forms of communication, digital or analog, can increase or decrease individual engagement depending on how they are implemented. You may communicate more effectively when you use health literacy principles to inform and educate the public. Putting health literacy and digital literacy principles into action may advance health equity because these principles are more likely to meet their cultural, linguistic, environmental, and historical needs and priorities. Health literacy principles make information clearer while health equity principles make information more inclusive. These are principles you could include:

• Use plain language;
• Offer individuals access in multiple languages;
• Provide translation services for people with limited language skills;
• Test materials with your intended audiences;
• Design websites to be accessible to people who need assistive technology (e.g., screen readers technology);
• Design web pages to load as quickly as possible to serve users with limited data or slow connections;
• Allow individuals to communicate through mobile devices that may be more readily available

How Do Individuals Want to Communicate?

When designing individual-to-provider communication strategies, consider that not all individuals prefer, or are able, to communicate in the same way. Preferences may vary widely across demographics (such as age groups and socio-economic status). Therefore, you may want to ensure your communication channels are aligned with the needs of your populations. While a single channel (such as a web-based individual portal) may reach many individuals, we encourage you to ask questions, such as:

• Who may be left behind?
• For individuals with limited or no digital access, which communication methods can be used to reach them?
• Are diverse and culturally and linguistically competent communication options available to populations?
• Have individuals been asked how they want to communicate?

The United Kingdom is an example of a country asking these types of questions. Their research has revealed that they should pursue multiple communication channels to reach the most individuals.

United Kingdom | From Around the Globe

Reach Out to People Where They Are

A study of United Kingdom cancer patients reported that “people respond to different kinds of support… the touch from someone who cares; the conversation with a friend, and the programme on TV. Support can also be from an article in a newspaper, a telephone call to a support group or in a discussion thread from an e‐community… Multi‐channel communication presents many opportunities to increase the impact of support available.“ (93) Therefore, individuals in the country respond differently to different outreach methods so having multiple outreach methods is beneficial.

In addition to the United Kingdom, many GDHP members offer several communication channels, including three or more of the following: telephone, email, in-person, mobile app, text message, paper mail, and portal. You may want to analyze at a more granular level whether the appropriate channels that are right for your population are being used within your country. Each of the examples below may benefit from multiple communication channels:

• Individuals’ medical questions to providers;
• Individuals’ requests for appointments;
• Individuals’ requests for prescription refills;
• Individual-generated health data;
• Individual-reported outcomes and experiences;
• Individuals’ end-of-life directives;
• Providers’ recommendations for healthy lifestyle to maintain wellness;
• Providers’ reminders of upcoming appointments; and
• Providers’ announcements of community events.

Understanding the diverse needs and preferences of the individuals you serve will help you know how to communicate inclusively. For example, Poland describes using natural language processing to address language barriers to ensure they reach out to all populations.

Poland | From Around the Globe

Inclusion and Diversity in eHealth Communication

Poland designs eHealth services with respect to the needs of different groups of individuals. For example, in 2022 the national individual portal version in Ukrainian was launched as well as an application (LikarPL) which uses natural language processing to support efficient communication between a doctor and  an individual who do not speak a common language. (94)

Individual-to-Provider Communication Recap

Individual-to-provider communication tools for success include these actions you may want to consider:

• Offer your individuals the ability to ask their providers questions without having to return in-person;
• Ensure communication is encrypted so individuals are able to trust the security of the messages;
• Apply health literacy and health equity principles when communicating; and
• Communicate through channels individuals prefer.