January, 2017 - SUPPORT Summary of a systematic review | print this article |

Can email communication between health professionals improve healthcare?

The use of email as a medium for business and social communication is increasingly common. Healthcare professionals have been communicating via email since the early 1990s, for varying purposes. However, it is not clear what the impacts of emails in healthcare are when compared to other forms of communicating clinical information.

Key messages

  • Email reminders may improve health professional practice.
  • Effects of email communication on health service outcomes and potential harms are uncertain. No studies were found evaluating this.
  • Only one study in a high-income country was identified.

Background

The use of email as a medium for communication might have several advantages, such as timely and low-cost delivery of information in comparison to other types of written communication, but it may also have disadvantages, such as concerns regarding privacy and potential misuse of information and increased workload.

 

 



About the systematic review underlying this summary

Review objectives: To assess the effects of healthcare professionals using email to communicate clinical information compared to other forms of communicating clinical information
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies evaluating email for two-way clinical communication between healthcare professionals
One randomised trial evaluating an electronic medical record reminder delivered to primary care physicians compared to a control group (usual care pathway)
Participants All healthcare professionals originating the email communication, receiving the email communication, or copied into the email communication

Women aged 50 to 89 who had suffered a fracture

and had not received bone mineral density measurement or medication for osteoporosis


Settings Any setting, including primary care settings, outpatient clinics, community settings (public health settings), and hospital settings
Non-profit, health maintenance organisation in the USA
Outcomes Healthcare professional outcomes, patient outcomes and health service outcomes associated with whether email has been understood and acted upon correctly by the recipient as intended by the sender, and harms (e.g. effects on safety or quality of care, breaches in privacy, technology failures)
Health professional practice (whether the care provider ordered the test and/or prescribed the recommended medication); patient outcomes (women’s calcium intake, regular activity and calorific expenditure), and satisfaction with care and services received. Health service outcomes and harms were not reported in the study.
Date of most recent search: November 2013
Limitations: This is a well-conducted systematic review with only minor limitations

Goyder C, Atherton H, Car M, et al. Email for clinical communication between healthcare professionals. Cochrane Database Syst Rev 2015; 2: CD007979.

Summary of findings

The review found only one study, evaluating primary care providers who received patient-specific email reminders for their enrolled patients from the chairman of the osteoporosis quality-improvement committee, and then a reminder after 3 months in case they had not ordered a bone mineral density test or prescribed pharmacological osteoporosis treatment for their patients.

  • Email reminders may improve health professional practice, such as better test ordering and prescribing. The certainty of this evidence is low.
  • No studies were found evaluating email communication on health service outcomes.
  • No studies were found reporting on harms associated with email communication.

Email reminders compared to usual care

People              Health professionals managing female patients aged 50 to 89

Settings            A health maintenance organisation in the USA

Intervention     Email reminder

Comparison      Usual care

Outcomes

Absolute effect*

Relative effect

(95% CI)

Certainty

of the evidence

(GRADE)

Without
Email reminder

With
Email reminder

Patients receiving bone mineral density measurement or osteoporosis medication

59 

per 1000

516

per 1000

RR 8.69

(5.04 to 12.27)

Low

Difference: 457 more per 1000

(Margin of error: 240 to 670 more)

Health services outcomes

No included studies

-

-

Harms

No included studies

-

-

Margin of error = Confidence interval (95% CI) RR: Risk ratio GRADE: GRADE Working Group grades of evidence (see above and last page)

* The risk WITHOUT the intervention is based on the risk in the control group of the studies identified in the review. The corresponding risk WITH the intervention (and the 95% confidence interval for the difference) is based on the overall relative effect (and its 95% confidence interval).

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY

 

  • The review identified 1 study with 202 participants evaluating email reminders to improve test ordering and prescribing for osteoporosis.
  • Only one study was found in this review, conducted in a high-income country

 


The identified study evaluated one of the many potential uses of email communication for one specific condition.

The use of email as a medium for communication is increasingly common in low-income countries. However, email availability, technology, and regulations affecting the use of email, and health system constraints may limit the applicability of the findings of this study.


EQUITY
The study did not directly address equity.

Email communication might increase health inequities, disfavouring settings where access to email is reduced or restricted.

However, email is widely available and low-cost in comparison with other types of communication, so it might decrease health inequities, particularly in remote areas.


ECONOMIC CONSIDERATIONS
  • The study did not measure costs.
Email reminders may decrease costs compared with other types of reminders.
MONITORING & EVALUATION
Only one study (in one setting in a high-income country) was found that addressed a specific use of email communication - for a problem that may not be a priority in low-income countries.

Consideration should be given to monitoring both intended and unintended outcomes of changes in policy or the use of email for communication between healthcare professionals.

There is need for additional randomised trials evaluating email reminders in other settings and for other conditions.

There is need for additional randomised trials evaluating email for other types of communication between healthcare professionals.


*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: www.supportsummaries.org/methods


 

Additional information

Related literature

Atherton H, Sawmynaden P, Sheikh A, et al. Email for clinical communication between patients/caregivers and healthcare professionals. Cochrane Database Syst Rev 2012; 11: CD007978.

 

Atherton H, Sawmynaden P, Meyer B, Car J. Email for the coordination of healthcare appointments and attendance reminders. Cochrane Database Syst Rev 201; 8: CD007981

 

Meyer B, Atherton H, Sawmynaden P, Car J. Email for communicating results of diagnostic medical investigations to patients. Cochrane Database Syst Rev 2012; 8: CD007980.

 

Sawmynaden P, Atherton H, Majeed A, Car J. Email for the provision of information on disease prevention and health promotion. Cochrane Database Syst Rev 2012; 11: CD007982.

 

Shojania KG, Jennings A, Mayhew A, et al. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev 2009; 3: CD001096.

 

This summary was prepared by

Gabriel Rada, Health Policy and Systems Research Unit, P. Universidad Católica de Chile  

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Yannis Pappas and Airton Stein.

 

This review should be cited as

Goyder C, Atherton H, Car M, et al. Email for clinical communication between healthcare professionals. Cochrane Database Syst Rev 2015; 2: CD007979.

 

The summary should be cited as

Rada G. Can email communication between health professionals improve healthcare? A SUPPORT Summary of a systematic review. January 2017. www.supportsummaries.org

 

Keywords

evidence-informed health policy, evidence-based, systematic review, health systems research,

health care, low and middle-income countries, developing countries, primary health care

email, communication, information technology

 

This summary was prepared with additional support from:

 

 

The Health Policy and Systems Research Unit (UnIPSS) is a Chilean research collaboration for the generation, dissemination and synthesis of relevant knowledge about health policy and systems based at the School of Medicine of the P. Universidad Católica de Chile.



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