FPEN Internet
Training
http://fpen.org/train/
Handout: Advanced E-Mail
Revised: September 13th, 1999
Goals:
Know how to use an address book for e-mail addresses
Understand how to manage discussion list subscriptions.
Learn to manage large volumes of e-mail.
Be able to interpret the information in an e-mail header.
Understand how to attach a file to an e-mail message.
Understand how to forward your e-mail, create a signature file, and use encryption.
Understand the problem of SPAM and learn how to deal with it.
The importance of address books: Address books provide an easy way for you to address messages to one or several people. One can create entries in the address book for people to whom you write frequently. For example you can create the address book entry "Paul" which stands for "Paul Kleeberg <paul@fpen.org>". Typing "Paul" in the To: field will cause the mailer to substitute Paul’s full name and e-mail address. This allows the user to enter complex addresses without having to look them up. It will also assure that your have typed the address correctly
Attaching several addresses to one alias: Address books can also be used to create a "Mailing List." By attaching several e-mail addresses to a single alias, the author can send an e-mail message to a group of people using a single address.
Adding names to an address book: Many e-mail programs will automatically create an address book entry for someone if you select the appropriate item from the menu bar while you have a message from that person open. You can create an address entry manually by typing in your friend’s nickname and then entering the Internet address information. I strongly recommend that you use copy and paste to enter the address. It will prevent the typographical errors that can make a message undeliverable.
General: Mailing lists are the oldest push technology on the Web. They are also what made the Internet so popular among the scientific community early in its history. Mailing lists (also known as "listserv lists" or discussion lists) provide a mechanism by which the user can add themselves to a topical mailing list and immediately begin to receive messages from others interested in that topic.
Finding lists of interest: There are several sites that maintain searchable indices of Internet mailing lists. My favorite is Liszt http://www.liszt.com. As of this writing, Liszt has information for over 90,000 lists. These are arranged by topic area and may also be searched using keywords. They have an entire section in the index devoted to health.
There are several other searchable indices of Internet Mailing lists. None of them are all-inclusive. Pointers to them are included in the handout "Advanced E-Mail: Websites". An updated version will be available in class and can also be retrieved from the Web at http://fpen.org/train/email/email-sites.html.
Subscribing to lists: In most instances, you subscribe to a mailing list by sending an e-mail request to the list management software. In the case of Listserv or ListProc, the e-mail message is one line long and contains something like: "subscribe Fam-Med Paul Kleeberg". When you subscribe to a list, you are usually sent a welcome message that tells you important things about the list. It lets you know the appropriate topics for discussion, whom to contact in the event of problems, and how to get off the list. It is very important to save this message. It could save you a lot of embarrassment later.
An example of a welcome message for Fam-Med, a discussion list on Information Technology In Family Practice, can be found at http://fpen.org/Fam-Med/welcome.
Managing one's subscription: Most all mailing lists allow the user to change their subscription from one in which they receive each message individually as soon as they are posted to a digest form. Changing one's subscription to the digest form will cause all messages sent over a pre-determined interval to come to you grouped together in one message. All of the subjects appear at the beginning of the digest like a table of contents. Receiving mailings from lists as digests can be useful when you subscribe to several lists. It will decrease the number of messages you received in your mailbox. Another option, useful when one goes on vacation is to set one's subscription to "nomail" (Listserv) or "postpone" (ListProc). This will cause all messages to stop until ask them to start again. Messages that appeared in the interim will be lost. This option can be useful if you had to get permission from the list owner to join -- it will allow you to stop and start your mail without having to reapply for membership.
General: Saving e-mail is a very convenient way to keep track of your correspondence. Unlike paper mail, you can use a search engine to scan your entire mailbox looking for a message from a particular individual or for a particular word. And just like paper mail, you can arrange your mail into folders in order to make things easier to find. Most all e-mail packages allow you to sort your mail into folders.
Sorting your mail into folders: When you first start using an e-mail package you will start with some type of an "In" box and an "Out" box. You can then create folders to hold messages from a particular person, a discussion list or any topoic you choose. After you are done reading a message and you wish to save it, you can move it to a folder where it will be easier to find. Folders are also very useful when coupled with mail filters to help manage large quantities of incoming mail.
General: Mail filters are a convenient method for managing large amounts of incoming mail. Many of today’s e-mail packages come with this capability. A mail filter will search for a user-defined string of characters in the incoming e-mail message and, if it finds a match, take the action specified by the user. For example, one can create a folder for a discussion list such as Fam-Med and instruct your e-mail program to move all messages that come from the Fam-Med mailing list into in a folder called Fam-Med. The user can then browse the subject lines of all the messages in the Fam-Med folder at their convenience and open only those of interest to them. For some, this is more convenient than receiving the mailings from a list in digest form.
Understanding e-mail headers: Before one can create effective filters, one must have a basic understanding of the header attached to the e-mail message. Some e-mail packages will hide the bulk of the header from the user. This header appears before the text of the message and contains some seemingly incomprehensible information. Some of the lines in the header trace the path the message followed to get from the sender to you. These are the "Received:" lines. It also contains lines that start with "From:", "Reply to:", "Date:", "Subject:" and several others. When creating filters, one can specify one of these lines as the target field when searching for a match.
Understanding e-mail headers can also help in deciphering the reason an e-mail message came back as undeliverable. Additionally, when you send the same message to several people (as in an alias distribution list), it will help you determine who did not receive the message. It can also help you in fighting SPAM, that unsolicited e-mail advertising that has become quite an annoyance for many. More on SPAM later.
Creating mail filters: Each e-mail package that allows for filtering has its own way of creating them. Generally they appear in the form: "When ‘From:’ = ‘Fam-Med’, put the message in the folder ‘Fam-Med’". "When ‘From:’ = ‘Bozo’, put the message in the trash. "When ‘To:’ = ‘paul@fpen.org’, highlight the message in red.
General: Attaching files allow you to send formatted documents, executable programs, pictures, sounds or even movies to others via e-mail. You may wish to send an electronic version of meeting minutes or a map to your house for a friend coming in from out of town. You might even want to send a picture of your family to a friend in another continent. Attaching a file to an e-mail message an easy way to accomplish this. Most mailers allow the user to attach a document to an e-mail message. The mailer then encodes the attached file in a form that will pass through all of the e-mail gateways and switches without having the attached file become corrupted.
Sending a message with an attached file: Luckily this is rather easy. In most packages one merely selects the file from a dialog box and the mailing software does the rest. There are only two potential obstacles to this task. The first is determining whether or not the recipient has an application that can view the file you are sending. The second is determining the type of file encoding that the recipient can interpret. This encoding is used by the e-mail package to allow the file to travel with the message and not be corrupted. In most cases MIME encoding will work (sometimes known as AppleDouble). However, for sending to some older mailing systems, one must use Uuencode or else the attachment will be unreadable.
Retrieving a message with an attached file: With a good e-mail package this is even easier than sending the file. Many packages will detect the attached file, determine the encoding and automatically decode it. Some will even know which program was used to create the file and open it automatically when you click on the document’s icon that appears within the e-mail message. Most of the newer e-mail packages will allow you to pick the directory in which the attachments are saved to that they are easy to find. With less advanced e-mail packages this can be more difficult. Other times it can be difficult to determine what program was used to create the file so that you can view it.
Viruses and e-mail attachments: Caution should be used when opening files attached to e-mail. Any file from another computer no matter how trusted, may contain a virus. Some Microsoft files may contain macro viruses. These can effect users of Microsoft products regardless of the type of computer you have. The best practice is to only open files when you know who sent it to you, if you have an updated version of a virus protection program and you are in the habit of backing up your system regularly.
General: Using e-mail today is about as secure as talking on a cellular phone. Intercepting calls from an analog cellular phone is a trivial task for those who wish to do it. So also is sniffing a data line and intercepting passwords and message content. One way to prevent this is to send messages using encryption. Encryption encodes a message in such a form that it is unintelligible without the decryption key or without spending significant time and energy to crack the encryption code. The encryption key is given to the recipient at another time so that they are able to decode the message when they receive it. Many encryption methods also assure you that the sender of the message is who they say they are and not an imposter.
Using encryption to send secure mail: Recently this has become a lot easier for the average user to send secure encrypted mail. Several of the current e-mail packages integrate encryption tools into their interface through the use of a plug-in.
Using encryption to send and receive e-mail involves the creation of public and private keys. These are a key pair that you use to encode and decode your messages. They are also the keys you use to sign your messages and verify that the sender is really who they say they are.
The first step in sending encrypted e-mail to another person is getting their public key. Once you have it, you then use this key to encrypt the message. Once the message is received, your recipient uses their private key to decode your message.
When you send a message you can use your private key to sign the message. Upon receiving the message, your recipient can then use your public key to verify that you really are who you say you are.
Communicating with patients: The decentralized nature of the Internet itself, and the circuitous route that a typical e-mail message will follow, means that most e-mail should be considered a public communication unless encrypted. System administrators have access to incoming and outgoing messages. You also must be aware that recipients can easily forward e-mail and you have no control where it may end up. For this reason, communicating with patients about their health problems is a risky business.
For a more thorough discussion of the clinical use of electronic mail with patients, see The American Medical Informatics Association position paper: Guidelines for the Clinical Use of Electronic Mail with Patients, JAMIA, 1998;5:104-111. The entire document is available online at http://www.amia.org/pubs/pospaper/positio2.htm
General: Probably the most frustrating part of receiving e-mail today is dealing with SPAM. Spam is the term used for the unsolicited e-mail messages we receive promising to make us more money, improve our sex lives, or help us to find out information about each other. They are almost as bad as the telemarketers that call you just as you sit down to dinner. Unlike unsolicited FAXs, these are not yet illegal. Additionally, since the sender pays no postage to distribute thousands of messages, it is a very attractive method to try one's hand at getting rich quick.
Avoiding SPAM: This is difficult to do. There are several methods that spammers use to get your address. They "mine" them from newsgroups and discussion lists. There is also a trick to get your Web browser to send out your e-mail address. The safest way to avoid spam is to only join discussion lists in which you can hide your e-mail address. On my list and many others now this is the default setting. Avoid newsgroups and browse only reputable web sites. You could also leave the e-mail address information blank in your Web browser and use another application that you have to start in order to use FTP.
Dealing with it when it arrives: Since avoiding spam is close to impossible, we all have to find some way to deal with it. Probably the best method is to ignore it. Replying to a message that promises to take you off of their mailing list is a mistake. It only confirms to the sender that there is a person at this address who reads their mail. It is also common for a spammer to fake his return address. So blasting that address with the electronic copy of the Encyclopedia Britannica may wind up attacking an innocent person whose address was faked by the spammer. If you really wish to do something about it, you can read the headers in the e-mail message and find the Internet Service Provider (ISP) that is the originator of the spam. Write to them and let them know that someone is using their service to send unsolicited e-mail and include a copy of the message. It is in their best interest of the ISP to stop the spammer so irate recipients don’t retaliate by jamming the ISPs with multiple copies of the Encyclopedia Britannica. It also may become illegal to fake a return address when sending unsolicited mail so that the ISP may be able to prosecute the spammer.
Attaching a signature: One way to personalize your message is by attaching a signature. These are short three or four lines of text that are automatically placed at the bottom of your outgoing mail. In a sense it is like using personalized stationary but instead of having the identifying information on the top of the first page, it occurs at the end of the message.
Here is mine as an example:
Paul Kleeberg, M.D. O o paul@fpen.org Allina Health System -+---+- Voice: 612-775-1338 1375 Willow Street |_o_| Family Practice & Minneapolis, MN 55403 USA / \|/ \ Information Services
Forwarding mail: Sometimes it is impossible to avoid having more than one e-mail address. Having several e-mail accounts can be a real pain if one has to log into each of them in order to check the mail. Some e-mail packages will allow you to check several accounts easily. However if the mail system resides on a UNIX machine, you can have all your mail from that site forwarded to another mailbox. In order to do this one must create a file called ".forward" (that is "dot forward") in your home directory. The file need only contain the e-mail address of the account to which you wish to have all your mail sent. As an example, my .forward file on a machine I seldom access would contain: paul@fpen.org. That would automatically forward all my new mail from that mailbox to my mailbox at fpen.org.
Managing multiple mailboxes on one machine: With many of the current e-mail packages it is possible to maintain several mailboxes for different people on one personal computer. Some e-mail packages can do this if you create separate preference files for each user and place it in its own directory. This allows for the coexistence of several e-mail boxes on one machine. This is very useful for the family PC at home or for the computer that is shared at the office. Netscape allows for the creation of separate preferences for their entire package so that different users may maintain their own bookmarks and e-mail files.
Vacation messages: Though these seem clever they are dangerous. Vacation messages are automatically sent by your e-mail package in reply to a message received. For each message that comes in they will send a reply to the sender stating that you are away on vacation and will read their message when you return. These can create havoc when the message originates from a discussion list. While the vacationer is off having a good time, his e-mail package sends a reply to the discussion list saying he will read it when he returns. This message is distributed to all on the discussion list – including his own mailbox. At this point the e-mail package dutifully replies to this new message that the recipient is away on vacation and will read it when he returns. Again this message is distributed to the discussion list generating another message that can generate another reply, etc. Some vacation programs are careful to only reply once to a particular address so loops like this do not occur. Some discussion list software can recognize vacation message loops and stop them before they cause problems. Personally I have never used them because I did not feel they were worth the risk. I have seen a list destroyed overnight by a vacation message that was caught in an infinite loop generating 15 megabites of mail sent to each member of the list in less than 24 hours!
Creating your own discussion lists: This is beyond the scope of this class but it is worth mentioning. A very useful Internet resource for this can be found at http://star.ucc.nau.edu/~mauri/moderators.html. Starting up your own discussion list on a topic near and dear to you is very rewarding. It can also be very time consuming. Given the right circumstances it can be an excellent source of learning and it can bring together people for discussion that might not have otherwise met. My list, Fam-Med, which focuses on information technology in family practice, allowed me to meet and remain connected to leaders in the field from my home in rural St. Peter, Minnesota.
Included are several resources. First is "E-Mail Web Sites," a listing of web sites that will provide additional information about the topics discussed in this paper. Next is a document that discusses appropriate e-mail etiquette when participating in a discussion group. Last are two articles that appeared in the Society of Teachers of Family Medicine newsletter which describe e-mail and discussion lists. Though they were written several years ago, they are still appropriate today.
An updated listing of URLs and the step-by-step instructions for hands-on portion of this class can be found at the URL http://fpen.org/train/email/.
Paul Kleeberg, M.D. O o paul@fpen.org Allina Health System -+---+- Voice 612-775-1338 1375 Willow Street |_o_| Family Practice & Minneapolis, MN 55403 USA / \|/ \ Information Services