Introduction
There are a number of ways in which fertility clinics can communicate with their patients online. It is worth checking with all the professional bodies of which you are a member for specific guidance and advisories. You should also check with your local medical council about advertising. The medical councils in some countries prohibit doctors from advertising their services. The nature of online communication means that clinics can advertise their services to audiences outside of their physical location. In light of the Covid-19 pandemic, fertility clinics have had to adapt and adopt a more online approach to communicating with patients.
Clinic websites
Your fertility clinic website is your shop window to the world. As such, you have a duty of care to ensure that the information provided is accurate and up to date. The first consideration for your website is security. It is important that your website has a secure sockets layer (SSL). This protocol for web browsers and servers allows for authentication, encryption and decryption of data sent over the Internet. This is displayed via the URL with https://. This is crucial if your site has a payment portal and if you collect patient data.
In October 2020, a joint cybersecurity advisory was co-authored by the Cybersecurity and Infrastructure Security Agency (CISA), the Federal Bureau of Investigation (FBI) and the Department of Health and Human Services (HHS) in the USA. This advisory describes the tactics, techniques and procedures used by cyber criminals to target the healthcare sector for financial gain (1).
It is worth investing in a web expert either in-house or engaging the services of a specialist provider to ensure your site is visible on the web and that the site is secure.
Since fertility patients will be looking at a number of clinics, your website needs to be transparent with easily accessible information. More specifically, patients are most interested in your success rates, treatment price list and accreditation. The hardest element for patients is to compare success rates between clinics. Try to make yours as clear and concise as possible to enhance the patient experience.
Depending on where you are based and where you expect your visitors to be located you will also need to ensure that your privacy policy and your terms and conditions are clearly displayed. If you expect your website visitors to be in Europe then you will need to be GDPR-compliant. As a medical facility you will already have systems in place to protect patient confidentiality and this also applies to all data that you collect via your website. Your website may connect to a customer relationship management (CRM) system. If so, you need to ensure that these data are stored securely and are not accessible via your website.
For information and tips for best practice on your website, please read this blog (2).
Data collection and storage
You can collect patient data in a number of ways. You may have an online contact form via your website. This would usually document the patient’s name, date of birth, home address, contact phone number, email address and medical history. When a patient enters this information, you need a disclaimer to advise them on how this data will be stored and have an opt in if you intend to keep this data for future marketing purposes.
All data that you collect must be stored securely with only a limited number of staff having authorised access to this information.
Social media
Social media refers to all public networking platforms where patients can interact with you as a service provider and other patients. These platforms provide an excellent opportunity for fertility clinics to share educational content. They are a good marketing tool to inform patients about specific infertility problems and demonstrate the expertise of your clinicians.
These platforms also provide an opportunity to broadcast in real time directly to patients and take live questions. It is important that your social media channels are monitored daily and that you have a dedicated team to generate content and monitor public comments.
According to the American Society for Reproductive Medicine (ASRM) guidelines on the use of social media in reproductive medicine:
- Patients use social media to get help and support
- Women are also more likely to use social networking and health-related websites than men
- Infertile women and couples often use web-based information when selecting a medical practice
- Social media presents unique opportunities; however, challenges also exist, specifically concerning online etiquette, outreach, ethics and patient privacy (3).
Social media has the ability to reach large audiences to recruit both patients and donors. Medical providers have an ethical obligation to provide accurate, transparent information. Clinics must avoid misrepresentation or the overestimation of important metrics such as success rates.
In the USA, all assisted reproduction providers are required by law to report success rates to the Center for Disease Control (CDC). In the UK, all assisted reproduction providers report their success rates to the Human Fertilisation and Embryology Authority (HFEA). This area of misrepresentation of success rates is heavily regulated in the USA.
The Society for Assisted Reproductive Technology (SART) in the USA has a condition of membership that fertility clinics must adhere to its advertising guidelines (4). Additionally, it is understood that the provision of information and education is the central purpose of many social media posts by healthcare providers. However, this must be balanced against the ethical risks posed by giving medical advice to individuals who are not yet established patients.
Furthermore, when patients ask for direct medical advice, it is important to take the conversation out of the public domain. You can publicly reply that you will send the patient a direct message. In a private conversation you can then arrange for the patient to speak directly with the medical team, thereby creating the secure electronic patient record.
Video communication
In light of the Covid-19 pandemic, fertility clinics have had to make operational changes to replace in-person consultations with virtual consultations. For some clinics, the transition was easy if they were already providing video consultations to overseas patients. But for other clinics, the transition to telemedicine can be more of a challenge. In light of this change ASRM put together a taskforce to highlight the pitfalls for clinics when using video communication platforms to communicate with patients (5).
Regardless of your location, you are advised to follow best practice where regulation does exist. Clinics in the USA must adhere to the Health Insurance Portability and Accountability Act (HIPAA). Therefore, when choosing a suitable video communication platform, it is important to realise that free video platforms are not designed for secure patient interactions and may put your clinic and your physicians at risk. To meet HIPAA compliance, you should subscribe to a video conferencing platform that offers high-level encryption. Most subscriptions exceed federal requirements. It is also important that, as a healthcare provider, you enter a contract with your video conferencing provider. This ensures that you share liability in the event of a data breach regarding patient information. The video conferencing software must also demonstrate an audit trail of users who access the patient information with a date and time stamp. You can get more information on HIPAA-compliant video conferencing software here (6).
You may also find these FAQs useful (7).
Express permission must be given if for any reason you wish to record the patient consultation. It is also the responsibility of the healthcare provider to record the consultation on their own server and not on that of a third party. If you communicate with a patient in a non-secure fashion then you leave yourself open to litigation.
Electronic communication with patients definitely enhances their patient experience with your clinic. However, as the healthcare provider, there are many pitfalls to consider and some serious investment in your information technology systems is required to ensure patient confidentiality. As previously mentioned, electronic communication for US clinics is also covered by the HIPAA Act and remains good practice for other healthcare providers to follow regardless of physical location (6).
It is important to remember that IVF patients may move to another healthcare provider and will therefore require a copy of their medical record. The easiest way to send this information is electronically and preferably through a secure patient portal.
The benefits of electronic communication are:
- patients can send their medical record and previous tests results prior to a video consultation with a physician
- healthcare providers can relay information like test results, treatment plan and specific questions in a timely manner
- patients are able to ask questions that occur to them after their consultation
- physicians can send more detailed information on specific procedures or conditions requiring management
- improves the patients’ perception of your clinic and the availability of your team in terms of offering a personal, individualised treatment plan
- offers care and treatment in real time
- reduces the amount of time spent on phone calls and in-person visits.
The disadvantages of electronic communication are:
- managing patient expectations – be clear in your communication as to when patients can expect a reply. Sometimes, your reply may be instant during office hours, but patients may expect the same swift response during out of clinic hours
- assumption that a named member of staff is always available to them – highlight that urgent enquiries should be directed to reception so that an available team member can advise in an emergency
- misunderstandings – a healthcare professional will pick up on patient gaps in knowledge with regard to medication instructions in a conversation that may not be picked up in electronic communication
- stand-alone communication via email may not be linked to the patient record, therefore it is important to either integrate emails to patient records or to copy in all members of the team who may communicate with the patient
- security and privacy of emails – you need to consider who can view internal emails and if patient information can be accessed by admin staff who do not have the patients’ permission to view their records
- all staff communicating with patients should bear in mind that everything they put in writing could end up in the public domain if used as evidence in a lawsuit.
Mobile messaging
Many clinics have responded to the patient demand to communicate via mobile messaging services such as Facebook messenger, SMS messaging and What’s App. This also has advantages and pitfalls that healthcare providers must manage to ensure they are compliant in terms of patient information. This form of communication is excellent for responding to patients in real time and gives a personal touch to communications. However, like email communications, healthcare providers are liable for all information put in writing in this format. And like social media platforms, this form of communication should only be used for engagement and lead generation. If you publish a dedicated number on your website and social media channels then ensure that a dedicated member of staff checks these messages daily. Also ensure there is an out of office reply to manage patient expectations.
If you wish to communicate with patients via mobile messaging, you should ensure messages are encrypted. Medical history and treatment protocols should not be discussed via this method of communication. Instead, this method can be used to establish the patient’s status and eligibility to open a patient record. The aim here is to move the patient from an initial enquiry to a medical consultation. No medical advice should be offered via this platform. The non-medical aspects of a patient’s treatment such as travel arrangements can be discussed but should be followed up in writing via email.
Newsletters
Newsletters are a powerful tool in your marketing toolbox and should be used to your best advantage. Have a good reason to send your newsletter. Keep it short and simple. Have three key messages that you want to convey. The purpose of a newsletter is to educate your patients, who may be past, present or future. Remember, an IVF patient takes on average of two years to decide on their course of treatment and their treatment provider, so your communication relationship with the patient is likely to be longer than your actual relationship with them as a patient!
Your newsletter needs to convey news from your clinic that is beneficial to the patient. Examples of this are new techniques that have met with success, new equipment that will improve patient outcomes, and new members of staff who bring experience and commitment to patient care. You may wish to announce live social media sessions with physicians or educational seminars that you are running. Make your content engaging, share research and your insight into the world of assisted reproduction. Keep items to a couple of paragraphs and then link to the full article on your website.
For more information on newsletter best practice, please read this blog (8).
Donor selection databases
It is becoming more common practice among IVF Units to allow intended parents to access a database of both egg donors and sperm donors to make their selection. These databases hold the key characteristics of donors such as height, weight, eye colour, hair colour, level of education and a photograph to compare their likeness to the recipient. Obviously, this level of information is reassuring to patients but holds a number of challenges for the healthcare provider. These databases should be stored on the clinic’s own server as opposed to a third-party server. Access to these databases requires a protected layer of security.
Firstly, the main concern is security to ensure that this sensitive information is only accessed by intended parents. There is also the issue of anonymity. Anonymous donation is not allowed in certain countries including the UK; therefore, patients may look to overseas clinics to seek an anonymous donor. However, in light of DNA testing and social media, it is best practice to advise patients that anonymity may not last forever. The European Society of Human Reproduction and Embryology (ESHRE) is currently in the process of drawing up new guidelines on Good Practice recommendations to provide information to those using and participating in reproductive donation (9).
Standard practice is for both donors and recipients to undergo psychological evaluation and counselling to fully understand the implications of using donor eggs or sperm. This would be separate from the medical advice given on the procedure per se.
Virtual educational events
Prior to Covid-19, it was common practice for clinics to hold open evenings and invite potential patients into the clinic for a tour. This was also a good opportunity for the physicians to make a short presentation and for patients to meet the nursing and case coordinators in person. The old adage applies here – ‘people buy people’. Since the pandemic, clinics have had to convey this personal touch via online seminars. Although the impact is not the same, if done correctly the warmth and empathy of the healthcare providers can still be conveyed.
Patients feel disconnected from their healthcare providers, so it is important to select a subject matter that patients will find engaging. Be mindful of awareness days each month and tailor your content around the general conversation, for example PCOS Awareness Month. This is a great example of how you can show transparency. Very few PCOS patients will actually need IVF. Indeed, current data suggest that only about 5% of PCOS patients go on to have IVF. However, PCOS is one of the leading causes of infertility. These patients are desperate for information and need to have the condition managed. Therefore, running an educational seminar will see good engagement and attendance and puts your clinic in a good position. Remember IVF patients are active on social media and a lot of your referrals will come through word of mouth.
It is best practice to keep your seminars short and informative; this should not be used as a sales pitch! Ideally, you should allow between 30-45 minutes for the entire seminar from start to finish. Include question time at the end and provide a contact email address for patients to follow up in a private conversation. Remember some patients are not confident enough to ask what they feel might be perceived by others as a pointless question .
Consent forms
There are a number of consent forms that patients must fully understand and sign before treatment commences. Counselling should also be offered prior to signing any consent forms. These consent forms should include:
- how long eggs, sperm or embryos can be stored
- the type of treatment the patient will undergo, including donation
- who will be the legal parent of a child born if donated eggs, sperm or embryos are used
- the child’s legal parent if the intended parents are not married or in a civil partnership
- what happens to eggs, sperm or embryos if either patient dies
- how a patient’s personal information can be used.
For more detailed information on informed consent, please see the next sections 4.2.2 and 4.2.3.
The HFEA in the UK has an in-depth section on consent forms for patients, which you should familiarise yourself with to ensure best practice (10).
Conclusions
As clinics adapt to the challenges of the Covid-19 pandemic, it is apparent that online communication now plays an integral role in the operation of IVF units. It is vitally important that clinics invest in information technology to ensure security and safety of patient data. It is also important to appreciate that all forms of online communication leave an audit trail and that, as healthcare providers, the duty of care extends beyond the physical location of the clinic. To meet patient expectations and remain competitive, it is also crucial for clinics to adapt to new technologies and engage with patients in a format that patients are most comfortable with. For more information on the Marketing of IVF Units and Agencies please see here 11.
Resources
- https://us-cert.cisa.gov/ncas/alerts/aa20-302a
- https://thefertilityhub.com/best-practice-on-your-website/
- https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/ for-non-members/social_media.pdf
- https://www.sart.org/globalassets/__sart/members-only-documents/sart-policies/sart-advertising-policy. pdf
- https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/ for-non-members/text_email_video_communication. pdf
- https://www.healthit.gov/topic/health-it-initiatives/ telemedicine-andtelehealth
- https://www.hhs.gov/sites/default/files/ telehealth-faqs-508.pdf
- https://thefertilityhub.com/the-power-of-newsletters-during-the-covid19-crisis/
- https://www.eshre.eu/Guidelines-and-Legal/ Guidelines/Guidelines-in-development/Information-provision-in-donation
- https://www.hfea.gov.uk/choose-a-clinic/consent-to-treatment/
- Montgomery, V. (2016), Organization and Management of IVF Units – a practical guide for clinicians. Springer 329-341.