The Single Best Way to Increase Patient Satisfaction and Prevent HIPAA Violations

Everybody wants to increase patient satisfaction, and everybody wants to avoid HIPAA violations. Basically all medical practices share these two goals, but what if there were a way to accomplish both of them at the same time?

Well, I think there is. Let me give it to you straight first, and then read on for my reasoning. The single best way to increase patient satisfaction while also preventing HIPAA violations is to:

Find out how your patients want to communicate and then…communicate with them that way.

It sounds simple, but most practices aren’t doing it! Patients have definite communication preferences, and ignoring them sets you up for HIPAA violations, malpractice lawsuits, lower satisfaction scores, worse health outcomes, and probably several other types of medical evil. Let’s go through the evidence.

Good Communication Improves Patient Satisfaction and Health Outcomes While Reducing Malpractice Lawsuits

Studies have linked many communication-related topics to eventual patient satisfaction. Patients like to feel, for instance, that you’re spending time on them, that you understand their expectations clearly, and that you’re discussing important subjects, such as the likely causes of their symptoms and how long they can expect to be sick.1,2 Every therapeutic relationship is unique, but your patient’s underlying perception of how well you communicate will certainly impact their satisfaction.

Patient satisfaction also has consequences that extend beyond just Press Ganey scores, with meta-analysis indicating that the doctor-patient relationship has a small but statistically significant effect on actual healthcare outcomes.3 Other studies are suggestive, too, including one that showed reductions in symptom length and severity among patients with the common cold when they felt that their clinician was maximally empathetic in their interactions.4

Increased satisfaction also prevents medical lawsuits. In one large study, 75% of patient complaints were related to “communication” problems rather than “care” issues, and the authors noted a 6% increase in complaint rate for each one-point drop in satisfaction score (on a scale of five).5 The authors then correlated satisfaction scores to eventual risk management cases and found that each one-point decrement in satisfaction was associated with a 5% increase in the probability of a risk management episode.

For illustration, here are the risk management episodes among the top third, middle third, and bottom third of physicians by patient satisfaction score:

Patients Have Strong and Evolving Communication Preferences

Society in general has undergone a recent sea change in communication patterns, with new modalities like texting, email, online messaging, and social media becoming increasingly popular, and medicine is not exempt from this trend.

Nearly 20% of patients, for instance, report contacting their physicians via social media, often despite provider resistance or institutional policies forbidding it.6 Two-thirds of patients would also choose a physician who offers a patient app over one who does not, and approximately 50% of patients now either use or want to use email to contact their healthcare providers.6,7 Meanwhile, traditional medical record portal sites have struggled to break 30% adoption among patients, despite wide availability and reimbursement incentives.8,9

In fields outside of medicine, reports now suggest that 30% of people no longer listen to their voicemail, 82% of people want to contact companies through means other than the phone, and 97% of smartphone owners regularly use their phone for text messaging, making it the most common activity on the devices, even above voice calling.10-12

If most of your medical communication is occurring over typical phone calls, you’re probably not meeting your patients where they want to be or in the way that would be best for their satisfaction and health. Check out our full ebook on the subject if you’re still unconvinced; I promise you these trends are real.

Patient Communication Preference Is Protective Under HIPAA

Healthcare has been slow to adopt new communication channels in part because HIPAA has strong requirements for privacy and electronic information security. Technologies like email and texting often appear to fall short of what the law demands, as they lack support for encryption and other important technical features, but this interpretation of the regulations is only partially accurate.

According to repeated guidance from the U.S. Department of Health and Human Services (HHS), the regulatory body that administers HIPAA, patient preference can overrule technical considerations. In the HIPAA Omnibus Rule commentary, for instance, HHS states, “We clarify that covered entities are permitted to send individuals unencrypted emails if they have advised the individual of the risk, and the individual still prefers the unencrypted email.”13

HHS also separately notes that “an individual has the right under the Privacy Rule to request and have a covered health care provider communicate with him or her by alternative means or at alternative locations, if reasonable,” so there may actually be an obligation in some cases to use modern communication channels with your patients.14

The government’s position is clear: Informed patient preference can be protective against what might otherwise be a HIPAA violation. We’ve discussed this in greater detail before, too, if you’re curious about the full story.

What You Should Do About All This

What you should do with all of this information is actually pretty straightforward, and both you and your patients are likely to love the outcome. Let’s run through the steps:

  1. Ask your patients how they want to communicate
    Give them options, including new modalities (like texting!), and make sure that they’re aware of any security limitations and reasonable alternatives.
  2. Document their consent and preferences
    Signed in person is best, as always, but any documentation is better than nothing.
  3. Communicate with your patients!
    Use those newly discovered preferred channels to communicate with your patients. Modern technology (like Spruce) can make this easy and efficient for you, letting you delight your patients without burdening you or your staff.

See? Pretty simple. Good communication can increase patient satisfaction while protecting you from HIPAA violations; there’s no reason not to do it.

Want to learn more about improving your medical communication? Spruce can help you take your practice to the next level, delighting your patients while keeping everything safe and HIPAA-compliant.

Get started with Spruce so we can help you reach your communication goals.

This article is part of a series of posts relating to HIPAA law and regulation. The information provided is meant as general guidance only and is not intended to be legal advice.


  1. Lin, C. T. et al. Is patients’ perception of time spent with the physician a determinant of ambulatory patient satisfaction? Arch. Intern. Med. 161, 1437–1442 (2001).
  2. Jackson, J. L., Chamberlin, J. & Kroenke, K. Predictors of patient satisfaction. Soc. Sci. Med. 52, 609–620 (2001).
  3. Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J. & Riess, H. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One 9, e94207 (2014).
  4. Rakel, D. et al. Perception of empathy in the therapeutic encounter: effects on the common cold. Patient Educ. Couns. 85, 390–397 (2011).
  5. Stelfox, H. T., Gandhi, T. K., Orav, E. J. & Gustafson, M. L. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am. J. Med. 118, 1126–1133 (2005).
  6. Lee, J. L. et al. Patient Use of Email, Facebook, and Physician Websites to Communicate with Physicians: A National Online Survey of Retail Pharmacy Users. J. Gen. Intern. Med. 31, 45–51 (2016).
  7. Steinfeld, J., Salesforce Research & Harris Poll. 2016 Connected Patient Report: Insights Into Patient Preferences on Telemedicine, Wearables and Post-Discharge Care. (Salesforce, 2016).
  8. Advisory Board. The truth about patient portal use. Advisory Board (2015). Available at: (Accessed: 24th August 2017)
  9. Neuner, J., Fedders, M., Caravella, M., Bradford, L. & Schapira, M. Meaningful use and the patient portal: patient enrollment, use, and satisfaction with patient portals at a later-adopting center. Am. J. Med. Qual. 30, 105–113 (2015).
  10. Smith, A., Page, D. & Pew Research Center. U.S. Smartphone Use in 2015. (Pew Research Center, 2015).
  11. Gladly. 2017 Customer Service Expectations Survey. (Gladly, 2017).
  12. Harris Poll & OneReach. The High Demand for Customer Service via Text Message: 2014 U.S. Survey Report. (Harris Poll on behalf of OneReach, 2014).
  13. Office for Civil Rights (OCR) & Department of Health and Human Services (HHS). 45 CFR Parts 160 and 164: Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules. Fed. Regist. 78, 5566–5702 (2013).
  14. Office for Civil Rights (OCR) & U.S. Department of Health and Human Services (HHS). 570-Does HIPAA permit health care providers to use e-mail to discuss with their patients. (2008). Available at: (Accessed: 23rd February 2016)

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