Health Professionals' Engagement With Email-Enabler or Disrupter?

The use of email is an internationally recognized and accepted method to communicate information in an asynchronous manner. Yet, despite its ubiquitous use, there is evidence that there are differences in the degree of engagement with and perceived value of email as legitimate work within the healthcare setting. A lack of engagement with email could have consequences on the care of patients if email communication is not read or responded to by the intended recipient. The purpose of this study was to understand the email practices of health professionals within a hospital setting, including their interactions, experiences, and thoughts and ideas for sharing information in the future. Four focus groups (total number of participants, 30) were conducted in 2015 and 2016 using an Appreciative Inquiry model to focus on the use of email. Data were thematically analyzed, with three overarching themes identified: professional practice, workforce self-care, and shaping the future using technology. Overall, email was perceived as a less important function within a health professional's everyday clinical practice; however, this differed depending on their role. The health professionals' use of email ranged from very little engagement to what could be judged as over-engagement, all of which have implications for healthcare organizations who view email as a legitimate work task and a key way to communicate.

Why "Reply All" Can Push All the Wrong Buttons

Technology has changed the way medicine is practiced. This commentary considers the effect of digital communications and offers advice on e‐mail etiquette.

Analysis of referrals after a synergic work between Primary Care and Urology. Impact of joint protocol implementation and a continuing education program in our healthcare area

OBJECTIVE

To analyse the evolution and adequacy of referrals from Primary Care to Urology, after the implementation of referral protocols on the most frequent urological diseases and the establishment of a continuing education program.

MATERIAL AND METHODS

A Primary Care-Urology work group was created in 2011. Initially, performance and clinical practice protocols in prostatic pathology (BPH and PSA) were established. These were supported by training sessions for primary care physicians. After analysing the effect of the mentioned joint work, 3more (scrotal pathology, urinary tract infections and urinary incontinence) were included. We analysed and compared the referrals and their adequacy before and after the establishment of the protocols.

RESULTS

The most common referral causes were symptoms of the lower urinary tract due to BPH, which initially represented 22.8% of the total, and decreased to 16.9%. After the introduction of the new algorithms, we observed a decrease in referrals for scrotal pathology (13-14% to 7.8%), an increase in urinary incontinence referrals (3% al 10.3%) and those related to urinary tract infections remained stable. The adequacy to the protocols improved progressively: LUTS from 46% to 65.3%; PSA from 55% to 84.4% and urinary incontinence from 66.2% to 73.1%. Adequacy in scrotal pathology decreased (de 67.1% a 63.3%), while in UTI it stayed much the same (around 76%).

CONCLUSIONS

The joint work between Urology and Primary Care achieves an improvement in referrals adequacy regarding the most frequent urological pathologies.

Email fraud: The search for psychological predictors of susceptibility

Decisions that we make about email legitimacy can result in a pernicious threat to security of both individuals and organisations. Yet user response to phishing emails is far from uniform; some respond while others do not. What is the source of this diversity in decision-making? From a psychological perspective, we consider cognitive and situational influences that might explain why certain users are more susceptible than others. Alongside an email judgment task employed as a proxy for fraud susceptibility, 224 participants completed a range of cognitive tasks. In addition, we manipulated time pressure for email legitimacy judgments. We identify cognitive reflection and sensation seeking as significant, albeit modest, predictors of susceptibility. Further to this, participants asked to make quicker responses made more judgment errors. We conclude there are cognitive signatures that partially contribute to email fraud susceptibility, with implications for efforts to limit online security breaches and train secure behaviors.

Receipt of Tobacco Direct Mail Coupons and Changes in Smoking Status in a Nationally Representative Sample of US Adults

Introduction

Direct-to-consumer tobacco marketing, including direct mail and email coupons, is a potentially influential marketing strategy. We examined the associations between receipt of tobacco direct mail/email coupons and trajectories of smoking behavior among US adults.

Methods

Data were from the US Population Assessment on Tobacco and Health (PATH) Study adult sample (n = 32160) collected during 2013-2014. Participants self-reported their smoking status (every day, some days, not at all) 12 months prior to the survey (T0) and at the time of the survey (T1). Three smoking trajectories were identified: nonsmokers progressing to current smokers, current smokers continuing to smoke, and among current smokers at T0, progressing to or continuing with daily smoking. Participants also reported receipt of direct mail/email tobacco coupons in the 6 months preceding T1 (yes/no). Weighted multiple logistic regression models were used to test the associations between receiving direct mail/email tobacco coupons and different smoking trajectories adjusted for demographic characteristics.

Results

One in eight (12.4%) US adult nonsmokers and 36.2% adult smokers at T0 reported receiving tobacco coupons. Receipt of tobacco coupons was negatively associated with poverty status. Receipt of tobacco coupons was associated with increased odds of progression to current smoking (AOR = 1.76, 95% CI = 1.45 to 2.12), continuation of smoking (AOR = 1.34, 95% CI = 1.09 to 1.65), and current smokers' progression to or continuation with daily smoking (AOR = 1.70, 95% CI = 1.50 to 1.91).

Conclusions

Direct-to-consumer tobacco coupons may promote progression of smoking among nonsmokers, and continuation of smoking and progression to daily smoking among smokers in US adults.

Implications

Distributing direct mail coupons is a strategy employed by tobacco companies to promote their products. We found, in a US national study, that many adults received tobacco coupons, and receiving these coupons was associated with subsequent progression of smoking among nonsmokers, and continuation of smoking and daily smoking among smokers. Scrutiny over the use of direct mail coupons and its effects on population health is warranted. Future research is needed to evaluate the effect of different interventions to reduce the impact of these coupons on smoking behaviors.

Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year

RATIONALE AND OBJECTIVES

We report the development of a new "Case of the Day" (COTD) educational initiative using email, social media (SoMe), and a website to disseminate content, as well as its trends in viewership and assessment of utility for the first year of implementation.

MATERIALS/METHODS

Using an image-rich format, a new unknown case was disseminated to radiology trainees and attendings at our institution by email twice per week, including history, salient images, and follow-up questions. Simultaneously, content was externally disseminated on Twitter and a publicly viewable departmental website. On subsequent days, the answer was posted via email, Twitter, and website in the form of a brief YouTube video lecture. Viewership data were collected over the first 12 months (July 1, 2016 to June 30, 2017), and an anonymous survey of participants was performed.

RESULTS

Sixty-five COTDs had complete viewership data and were included in our analysis, yielding 4911 "case" email views (mean = 76), 3798 "answer" email views (mean = 58), 68,034 "case" Twitter impressions (mean = 1047), 75,724 "answer" Twitter impressions (mean = 1164), 5465 "case" Twitter engagements (mean = 84), and 5307 "answer" Twitter engagements (mean = 82). COTD YouTube video lectures garnered 3657 views (mean = 61) amounting to 10,358 minutes of total viewing time. Viewers were very satisfied with COTD quality, with 97% (n = 63) reporting the quality as "good" or "excellent."

CONCLUSIONS

Email and SoMe can serve as effective tools for disseminating radiology educational content. SoMe offers substantial external visibility and branding potential for programs.

The new enhancement technologies and the place of vulnerability in our lives

What is the place of vulnerability in our lives? The current debate about the ethics of enhancement technologies provides a context in which to think about this question. In my view, the current debate is likely to be fruitless, largely because we bring the wrong ethical resources to bear on its questions. In this article, I recall an important, but currently neglected, role that moral concepts play in our thinking, a role they should especially play in relation to the introduction of new technologies. I call this the 'contemplative role of moral concepts'. I then contrast two approaches to the contemplative role of moral concepts which are found in the current literature, and show why it is important to keep in mind both of these approaches when thinking about human vulnerability.

Provider-to-provider electronic communication in the era of meaningful use: a review of the evidence

BACKGROUND

Electronic communication between providers occurs daily in clinical practice but has not been well studied.

PURPOSE

To assess the impact of provider-to-provider electronic communication tools on communication and healthcare outcomes through literature review.

DATA SOURCES

Ovid MEDLINE, PubMed, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Academic Search Premier.

STUDY SELECTION

Publication in English-language peer-reviewed journals. Studies provided quantitative provider-to-provider communication data, provider satisfaction statistics, or electronic health record (EHR) communication data.

DATA EXTRACTION

Literature review.

DATA SYNTHESIS

Two reviewers conducted the title review to determine eligible studies from initial search results. Three reviewers independently reviewed titles, abstracts, and full text (where appropriate) against inclusion and exclusion criteria.

LIMITATIONS

Small number of eligible studies; few described trial design (20%). Homogeneous provider type (physicians). English-only studies.

CONCLUSIONS

Of 25 included studies, all focused on physicians; most were observational (68%). Most (60%) described electronic specialist referral tools. Although overall use has been measured, there were no studies of the effectiveness of intra-EHR messaging. Literature describing the effectiveness of provider-to-provider electronic communications is sparse and narrow in scope. Complex care, such as that envisioned for the Patient Centered Medical Home, necessitates further research.

Faculty and student expectations and perceptions of e-mail communication in a campus and distance doctor of pharmacy program

OBJECTIVE

To examine faculty members' and students' expectations and perceptions of e-mail communication in a dual pathway pharmacy program.

METHODS

Three parallel survey instruments were administered to campus students, distance students, and faculty members, respectively. Focus groups with students and faculty were conducted.

RESULTS

Faculty members perceived themselves as more accessible and approachable by e-mail than either group of students did. Campus students expected a shorter faculty response time to e-mail and for faculty members to be more available than did distance students.

CONCLUSION

E-mail is an effective means of computer-mediated communication between faculty members and students and can be used to promote a sense of community and inclusiveness (ie, immediacy), especially with distant students.

Physicians slow to e-mail routinely with patients

Some experts view e-mail between physicians and patients as a potential tool to improve physician-patient communication and, ultimately, patient care. Despite indications that many patients want to e-mail their physicians, physician adoption and use of e-mail with patients remains uncommon--only 6.7 percent of office-based physicians routinely e-mailed patients in 2008, according to a new national study from the Center for Studying Health System Change (HSC). Overall, about one-third of office-based physicians reported that information technology (IT) was available in their practice for e-mailing patients about clinical issues. Of those, fewer than one in five reported using e-mail with patients routinely; the remaining physicians were roughly evenly split between occasional users and non-users. Physicians in practices with access to electronic medical records and those working in health maintenance organizations (HMOs) or medical school settings were more likely to adopt and use e-mail to communicate with patients compared with other physicians. However, even among the highest users--physicians in group/staff-model HMOs--only 50.6 percent reported routinely e-mailing patients.

A practical guide to the e-mail interview

The e-mail interview is a novel technique that has a number of advantages over traditional interviewing, but there are also some disadvantages. In this methodological article, the authors review the issues surrounding the use of the e-mail interview, providing a concrete example of its use, that of interviewing people with alopecia areata regarding psychological issues associated with the disorder. The authors show in the article that the e-mail interview is an effective interview technique but that users must take account of a number of sensitive issues, and there are a number of serious disadvantages that limit its use to specific areas. The e-mail interview cannot be used simply as a cheap alternative to face-to-face interviews in all circumstances.

Patient access to U.S. physicians who conduct internet or e-mail consults

BACKGROUND

E-mail communication has the potential to improve communication between patients and doctors.

OBJECTIVE

The objective of the study is to describe the access of patients to physicians who conduct e-mail consults.

METHODS

We analyzed data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative cross-sectional survey of office-based physician visits, in 2001, 2002, and 2003. The main outcome measure was the percentage of visits to a provider who reported doing internet or e-mail consults.

RESULTS

There was fewer than 1 in 10 outpatient visits in 2001 (9.2%) to physicians who reported doing internet or e-mail consults, and this did not increase in 2002 (5.8%) or 2003 (5.5%). Access to these physicians was greater among patients who were male, nonminority, lived in the Western United States, seen for pre-/postoperative care, seen by a primary care provider, and not seen by a nurse during their visit. Access to physicians who conducted internet or e-mail consults was independent of other patient (e.g., chronic conditions), provider (e.g., office setting), and visit (e.g., medications prescribed) characteristics.

CONCLUSIONS

Access to physicians who do internet or e-mail consults is generally low and did not increase between 2001 and 2003, despite growth in internet access and in other internet-related activities.

The internet and the global monitoring of emerging diseases: lessons from the first 10 years of ProMED-mail

Now in its eleventh year, ProMED-mail is a robust and sensitive mechanism for the discovery of emerging disease outbreaks involving humans, animals, and plants around the world and for rapid dissemination of information. Fast reporting translates into quicker arrival of prevention and control assistance from other countries, better advance warning to neighboring countries and intending travelers, and other benefits to public health such as heightened awareness of health workers to the threat, time to prepare countermeasures and to react in an appropriate manner rather than a reflex emergency response.

Creating new futures in nursing education: envisioning the evolution of e-nursing education

This article discusses the explosion of technology and its impact on nursing education in the face of a nurse educator shortage. An attempt is made to answer the following questions:What incremental changes in technology do we have now? How do we envision technology being used in the future? Four scenarios of nontraditional approaches to nursing education are presented. They touch on the delivery of education with increased technology and universal access; the teacher as educator/mentor/coach; the product, including testing, outcomes, competencies, and process; and attracting and keeping human attention. The final section focuses on issues to consider as nurse leaders and educators bring nursing education into the future.

The emerging role of online communication between patients and their providers

Despite the explosion of online communication in the community, its use between patients and their health care providers remains low. However, rapidly growing patient and provider interest in using online communication has motivated organizations to consider options for deploying these new tools in clinical practice. In this paper, we describe the barriers and challenges health care providers and their organizations must address in developing and deploying these new tools. We formulate lessons from early experiences with e-mail and web-based communication in clinical settings. Finally, we provide a roadmap for developing and deploying these new tools in clinical practice. Health care providers and their organizations will need to consider issues related to technology, data management, operations, communication management, and financial support in order to successfully deploy online services and communication for patients in clinical settings.

Pre-departure counselling and an email contact service for patients with epilepsy faring abroad for long periods of time

The fate and management of 50 patients with epilepsy is described whilst they undertook varied gap year experiences in various countries. Despite initial apprehension on my part almost all had no change in their epilepsy (or had actual improvement) and it turned out to be a positive experience for all. With the ready availability of email it is suggested that the home clinic keeps in touch with gap year students whilst they are away and provides them with basic information and an assessment before they go, information which they can then take with them.

Results of a content analysis of electronic messages (email) sent between patients and their physicians

BACKGROUND

Email is the most important mechanism introduced since the telephone for developing interpersonal relationships. This study was designed to provide insight into how patients are using email to request information or services from their healthcare providers.

METHODS

Following IRB approval, we reviewed all electronic mail (e-mail) messages sent between five study clinicians and their patients over a one-month period. We used a previously described taxonomy of patient requests to categorize all patient requests contained in the messages. We measured message volume, frequency, length and response time for all messages sent to and received by these clinicians.

RESULTS

On average the 5 physicians involved in this study received 40 messages per month, each containing approximately 139 words. Replies sent by the physicians contained 39 words on average and 59.4% of them were sent within 24 hours. Patients averaged 1 request per message. Requests for information on medications or treatments, specific symptoms or diseases, and requests for actions regarding medications or treatments accounted for 75% of all requests. Physicians fulfilled 80.2% of all these requests. Upon comparison of these data to that obtained from traditional office visits, it appears that the potential exists for email encounters to substitute for some percentage of office visits.

CONCLUSION

Electronic messaging is an important method for physicians and patients to communicate and further develop their relationship. While many physicians worry that either the number or length of messages from their patients will overwhelm them, there is no evidence to support this. In fact, the evidence suggests that many patient requests, formerly made over the telephone or during office visits, can be addressed via email thus potentially saving both patients and physicians time.

[Rheumatology online: A survey among the members of the German Rheumatology Society]

OBJECTIVE

On behalf of the "Systemic Inflammatory Rheumatic Diseases Network" comprehensive, nationwide horizontal and vertical cross-linking of research and care is to be developed for the first time. The quality of scientific work and patient care is to be increased in the medium term through this improved communication and co-operation. Our objective was to determine what hardware and software are avail- able to the physicians involved, with a view to the Internet being used as a basis for communication and documentation within the network.

METHODS

A survey was carried out among 723 active members of the German Rheumatology Society (DGRh). Data on the hardware and software used and on Internet access were collected using a unilateral questionnaire.

RESULTS

The response rate among the addressed rheumatologists was 55.3%, with 64.1% of members in private practice replying. Of those responding 85% have Internet access, with rheumatologists in private practice using the Internet significantly less frequently at work than those working at a hospital (42% vs 80%). The latter accordingly reported a higher proportion of medical Internet usage (69% vs 52%, p<0.001). The survey demonstrated that software for private practices and hospitals shows a very variable picture with a multiplicity of systems being used.

CONCLUSION

Use of the Internet for communication in the "Systemic Inflammatory Rheumatic Diseases Network" is practicable in hospitals but clearly restricted in the private practice sector. The widely varying software used in hospitals and private practices underlines the need for standardized, comprehensive documentation systems to be developed. To ensure acceptance and broadly based application, they need to be integrated into the existing computer infrastructure. In this context, Internetbased applications offer new opportunities through the use of system-independent file formats.

Electronic technology: a spark to revitalize primary care?

The computer revolution has enormous potential to improve primary care in the areas of medical records, communication between physicians and patients, information sharing among health care providers, and rapid access to reliable medical information for both physicians and patients. A number of barriers must be overcome before computerization is widely embraced in primary care: e-health often takes too much time and is too expensive; the quality of Web-based medical information is inadequate; software programs may not interact with one another; patient privacy must be protected; public and private insurers rarely pay for electronic communication with patients; and the computer could interfere with the patient-physician relationship. Studies have shown that some computerized systems, such as reminder prompts and physician performance feedback, may improve physician performance and patient outcomes, but if these systems are too time-consuming, physicians may not use them. If primary care practices are to benefit from the electronic revolution, they must redesign their clinical processes to ensure that e-health facilitates rather than hinders the work of physicians.

Use of the Internet and e-mail for health care information: results from a national survey

CONTEXT

The Internet has attracted considerable attention as a means to improve health and health care delivery, but it is not clear how prevalent Internet use for health care really is or what impact it has on health care utilization. Available estimates of use and impact vary widely. Without accurate estimates of use and effects, it is difficult to focus policy discussions or design appropriate policy activities.

OBJECTIVES

To measure the extent of Internet use for health care among a representative sample of the US population, to examine the prevalence of e-mail use for health care, and to examine the effects that Internet and e-mail use has on users' knowledge about health care matters and their use of the health care system.

DESIGN, SETTING, AND PARTICIPANTS

Survey conducted in December 2001 and January 2002 among a sample drawn from a research panel of more than 60 000 US households developed and maintained by Knowledge Networks. Responses were analyzed from 4764 individuals aged 21 years or older who were self-reported Internet users.

MAIN OUTCOME MEASURES

Self-reported rates in the past year of Internet and e-mail use to obtain information related to health, contact health care professionals, and obtain prescriptions; perceived effects of Internet and e-mail use on health care use.

RESULTS

Approximately 40% of respondents with Internet access reported using the Internet to look for advice or information about health or health care in 2001. Six percent reported using e-mail to contact a physician or other health care professional. About one third of those using the Internet for health reported that using the Internet affected a decision about health or their health care, but very few reported impacts on measurable health care utilization; 94% said that Internet use had no effect on the number of physician visits they had and 93% said it had no effect on the number of telephone contacts. Five percent or less reported use of the Internet to obtain prescriptions or purchase pharmaceutical products.

CONCLUSIONS

Although many people use the Internet for health information, use is not as common as is sometimes reported. Effects on actual health care utilization are also less substantial than some have claimed. Discussions of the role of the Internet in health care and the development of policies that might influence this role should not presume that use of the Internet for health information is universal or that the Internet strongly influences health care utilization.

[E-commerce of pharmaceuticals]

The emergence of the Internet as a new communications and information technology caused major social and cultural changes. The dramatic increase in accessibility and availability of information empowered the consumer by closing the information gap between the consumer and different suppliers. The objective of this article is to review many new internet-supported applications related to the pharmaceutical market. E-commerce is divided into two major components: Business to Consumer (B to C), and Business to Business (B to B). The main applications in B to C are dissemination of medical and drug information, and the sale of drugs through the Internet. Medical information on the Internet is vast and very helpful for patients, however, its reliability is not guaranteed. Online pharmacies increase the accessibility and availability of drugs. Nevertheless, several obstacles such as security of the data provided (both financial and clinical) prevent the widespread use of online pharmacies. Another risk is the health authorities' inability to regulate Internet sites effectively. Therefore, unregulated sale of prescription drugs, fake or substandard, often occurs on the Internet. B to B relates to physicians, clinics, hospitals, HMO's and pharmaceutical companies. There is a vast number of applications ranging from clinical research, marketing and sales promotion, to drug distribution and logistics. In conclusion, the Internet is dynamic and has contributed to the development of numerous new applications in the field of pharmaceuticals. Regulatory authorities should be active in developing new policies that will deal with those new Internet-based applications.

Doctors who are using e-mail with their patients: a qualitative exploration

BACKGROUND

Despite the potential for rapid, asynchronous, documentable communication, the use of e-mail for physician-patient communication has not been widely adopted.

OBJECTIVE

To survey physicians currently using e-mail with their patients daily to understand their experiences.

METHODS

In-depth phone interviews of 45 physicians currently using e-mail with patients were audio taped and transcribed verbatim. Two investigators independently qualitatively coded comments. Differences were adjudicated by group consensus.

RESULTS

Almost all of the 642 comments from these physicians who currently use e-mail with patients daily could be grouped into 1 of 4 broad domains: (1) e-mail access and content, (2) effects of e-mail on the doctor-patient relationship, (3) managing clinical issues by e-mail, and (4) integrating e-mail into office processes. The most consistent theme was that e-mail communication enhances chronic-disease management. Many physicians also reported improved continuity of care and increased flexibility in responding to nonurgent issues. Integration of e-mail into daily workflow, such as utilization of office personnel, appears to be a significant area of concern for many of the physicians. For other issues, such as content, efficiency of e-mail, and confidentiality, there were diverging experiences and opinions. Physicians appear to be selective in choosing which patients they will communicate with via e-mail, but the criteria for selection is unclear.

CONCLUSION

These physician respondents did perceive benefits to e-mail with a select group of patients. Several areas, such as identifying clinical situations where e-mail communication is effective, incorporating e-mail into office flow, and being reimbursed for online medical care/communication, need to be addressed before this mode of communication diffuses into most practices.

[IHE (Integrating the Healthcare Enterprise): a new approach for the improvement of digital communication in healthcare]

Parallel to the introduction of diagnosis related groups (DRGs) for the reimbursement of hospitals, a marked reduction of financial means within the healthcare system is taking place. Healthcare enterprise information systems will play an increasing role to accommodate the new working conditions by developing reliable and efficient workflow solutions. Interfacing the systems currently in use can meet considerable obstacles. By offering high connectivity, IHE (Integrating the Healthcare Enterprise), which was initiated by concerted actions of users and vendors, ensures improved health care delivery and, furthermore, assists in acquiring new information systems in the future. IHE is not a standard but makes extensive use of existing international standards, such as HL7 and DICOM. National IHE demonstrations confirmed the power of this approach and presented its mission to large groups of users and vendors. The concept continues to grow and for the first time provides groups of various interests cooperative solutions to the problems encountered in collecting and distributing information.