Remember, UpDox has a patient portal, which works reasonably well (see discussions in a separate thread.) There are lots of ways secure e-mail COULD work... we could tell all of our patients to get PGP for instance... but the trick is how to do it smoothly, without taking more than a few seconds per interaction, and without requiring any technical dexterity on the part of our patients. As I noted elsewhere, I think UpDox comes pretty close, but it is still twitchy enough to be an issue for my staff who have to provide tech support. I am still hopeful it settles down.
