Review question:

What are the effects of healthcare professionals using email to communicate clinical information to each other, on healthcare professional outcomes; patient outcomes; health service performance; and service efficiency and acceptability compared to the usual forms of communication such as face-to-face, postal letters, telephone, and text messaging?

Nursing Implications:

Email is a popular and commonly-used method of communication, but its use in healthcare is not routine. Nurses often need to discuss cases and liaise with doctors and other healthcare allies to coordinate patient care. There are advantages and disadvantages in the use of email for clinical communication and the effects of email use for clinical communication have yet to be established.

Study Characteristics:

This is a summary of a Cochrane systematic review. The review included one randomized controlled trial involving a total of 327 patients and 159 healthcare providers. There were two intervention arms of the trial which assessed the use of electronic medical record (EMR) reminders alone, or EMR + patient reminder, compared to usual care (no email reminder). However, to meet the objective of the review, only the comparison between the EMR reminder group (101 patients) and the usual care group (101 patients) was considered. Participants were women aged between 50 and 89 years who had suffered a fracture in 1999 and had not received bone mineral density (BMD) measurement or medication for osteoporosis. The intervention (EMR) was delivered to the primary care physicians of the patients to remind them of the patient’s risk of osteoporosis and the need for evaluation and treatment, as well as a reminder (three months later) for ordering a BMD

Measured outcomes included: (1) health professional actions and performance in terms of whether the care provider ordered a BMD measurement, and/or prescribed osteoporosis medications; and (2) patient outcomes including behaviors such as calcium intake and activity level and patient satisfaction with the care and services received for bone health.

This study was at high risk of bias due to inadequate allocation concealment and blinding and unclear risk of bias due to other sources, including use of a patient questionnaire that had not been validated.

Summary of Key Evidence:

As the review included only one study, it was not possible to conduct meta-analysis and the main findings were described using narrative summary. The results showed that the use of EMR prompts improved health professional actions/performance. Patients whose physicians received the EMR message were more likely to receive the recommended care; specifically, a BMD measurement (Odds Ratio [OR] 31.17; 95% confidence interval [CI] 4.13 to 235.51); a BMD measurement or osteoporosis medication (OR 16.80; 95% CI 6.75 to 41.85); or osteoporosis medication only (OR 3.27; 95% CI 1.02 to 10.51). Those in the usual care group were more likely to receive neither a BMD measurement nor osteoporosis medication (OR 0.06; 95% CI 0.02 to 0.15).

There was inconclusive evidence on the patient response. Participants whose physicians received the EMR message had a significantly higher calcium intake (P = 0.02) compared with those in the control group. However, differences in regular activity, calorie expenditure and satisfaction with care and services were not statistically significant between the two groups.

Overall, there was a lack of studies meeting the inclusion criteria. With only one study included in the review, the findings were incomplete with regard to outcome measures and applicability of evidence. The effects of email communication between healthcare professionals on provider and patient outcomes remains inconclusive.

Best Practice Recommendations:

Results of this review were inadequate to inform clinical practice in regard to the use of email for clinical communication between healthcare professionals. Future studies should focus on high quality RCTs to investigate the effects of email use and also examine the effects of technological developments, such as the  widespread use of ‘smartphones’, on the use of email communication.

Summary Author

LiHui Tay, BSc (Nursing) (Hons)
National University Cancer Institute
Singapore National University Health System

A member of the Cochrane Nursing Care Field (CNCF)