Effects of electronic communication in general practice

https://doi.org/10.1016/S1386-5056(00)00096-4Get rights and content

Abstract

Objective: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. Methods: We retrieved all publications in the English language indexed in MEDLINE under the MESH term ‘Computer Communication Networks’ AND having either ‘family practice’ or ‘primary health care’ as MESH term OR ‘GP’, or ‘GPs’ as text word. Results: A total of 176 publications were retrieved of which 30 publications met the criteria. In 28 of these 30 publications potential effects were described; one described claimed effects, three described demonstrated effects with subjective data and five described demonstrated effects with objective data. The studies documented, furthermore, effects on the speed of communication, the content of information and records, a change of processes involved in the communication, quality of care, costs, workload of physicians, appreciation of physicians, confidentiality, and adherence. Conclusions: We conclude that only a few studies evaluated electronic communication versus paper communication. Of these studies, only a few report improvement. Our final conclusion is that, so far, literature has not shown that the positive effects can be explained by electronic communication as such.

Introduction

In the Netherlands, most citizens are enrolled in the practice of a General Practitioner (GP). When seeking advice or treatment, the patient usually contacts his or her GP, who acts as a gatekeeper to the health care system. The GP may refer the patient to other specialists if necessary. The specialist reports back to the GP after diagnosis and/or treatment of the patient. Optimal diagnosis and treatment of the patient requires adequate communication between the GP and specialists involved. The continuity of care depends largely on the quality and frequency of communication between the involved physicians and a clear definition of their findings. [1], [2]. In the continuity of care, the general practitioner (GP) can be seen as the ‘information manager’. To do this task well the GP is dependent on the information provided by other members of the health care system, e.g. specialists.

However, a large number of studies have demonstrated that traditional paper-based communication between GPs and specialists about co-treated patients is prone to be

too slow: Studies have shown that 10–50% of discharge letters arrive too late [1], [3], [4], [5], [6]. A study in Spain even showed that in 78% of the referrals, the GP did not receive a discharge letter at all [7].

incomplete: Studies have shown that where panels rated letters, one in five were rated as inadequate, one in three were confusing, and only 50% were fully satisfactory [8], [9], [10].

inefficient: Most reports are created with computers, printed, then sent via paper mail, and again re-entered into a computer. The inefficiency hereof is obvious.

erroneous: Transcription of data has led to typing errors in a large percentage of cases [11].

The above bottlenecks in the paper-based communication between GPs and specialists can have a range of side-effects. Examples include [3]: unnecessary waste of time and irritation trying to obtain missing information or simply in processing the letter, suboptimal or even incorrect treatment, doubling of diagnostic tests, feelings of insecurity, anxiety or fear in the patient when the patient does not perceive the health-care system as a whole, and disturbances in patient–doctor relation. New technologies are emerging, and also in healthcare this resulted in operational information technology systems to document medical data in primary and secondary care. Such systems offer the potential for replacing traditional, paper-based communications by a more direct means of information exchange, namely from computer to computer. In this paper we will call the latter ‘electronic communication’. Although it is generally assumed that electronic communication has benefits, we started wondering as to what these benefits are, and how much evidence for such assumptions does exist. Furthermore, we also asked ourselves what the negative effects of electronic communication are. Since we did not find any reviews in literature on this topic, we decided to perform such a review, taking the GP as central stakeholder.

In this paper we studied the effect of electronic communication in general practice as described in peer-reviewed, relevant literature.

Section snippets

Obtaining the publications

Electronic communication, however, is not a MESH term. We therefore retrieved on August 19th 1999 all English publications indexed in MEDLINE under the MESH term ‘Computer Communication Networks’ AND having either ‘family practice’ or ‘primary health care’ as MESH term OR ‘GP’, or ‘GPs’ as text word. All retrieved publications were then read and checked independently by the authors to determine whether the publication fulfilled the following criteria:

  • 1.

    The publication had to describe

Results

In total 176 publications were retrieved from MEDLINE, of which 26 complied with all criteria. From the references in these 26 publications, we added another five publications that also met the criteria. One publication [12] was excluded because it was both indexed in a conference proceeding (MEDINFO) and in a special issue of a journal dedicated to that conference [13].

Discussion

In the last decades, the complexity and volume of medical knowledge and data increased. This development led to an increased specialization of the health-care professional and an increased number of health-care professionals involved in the care for a given patient. As the number of professionals involved in the care of individual patient increases, the need to ensure good communication also increases [4], [10], [43]. In a number of countries, the GP acts as a gatekeeper in the health-care

References (48)

  • L. Irazabal Olabarrieta et al.

    Does the communication between primary and secondary levels function?

    Aten. Primaria

    (1996)
  • N.J. Clinger et al.

    Radiology reporting: attitudes of referring physicians

    Radiology

    (1988)
  • P.W. Moorman et al.

    Are referring physicians satisfied with endoscopy reports?

    Z. Gastroenterol.

    (1994)
  • R.F. Westerman et al.

    A study of communication between general practitioners and specialists

    Br. J. Gen. Pract.

    (1990)
  • M. Khoury et al.

    Error rates in Australian chemical pathology laboratories

    Med. J. Aust.

    (1996)
  • P.J. Branger et al.

    Shared care for diabetes: supporting communication between primary and secondary care

    Medinfo

    (1998)
  • A. Ament et al.

    An economic evaluation in health care (3I-project)

  • G. Arnone et al.

    Easy Medic: an Internet application for the general practitioner

    J. Telemed. Telecare

    (1998)
  • P.S. Athwall, P. Martin, Use of international data communications standards in hospital laboratories. Proc. Annu. Symp....
  • G.R. Bergus et al.

    Use of an E-mail curbside consultation service by family physicians

    J. Fam. Pract.

    (1998)
  • R. Beuscart et al.

    A regional university hospital in the framework of a regional information network: the experience of Lille

    Stud. Health. Technol. Inform.

    (1998)
  • P.J. Branger et al.

    Electronic communication between providers of primary and secondary care

    Br. Med. J.

    (1992)
  • P.J. Branger et al.

    Communication in health care

    Methods Inf. Med.

    (1995)
  • J.S. Briggs et al.

    Lessons learned from an Internet GP information system

    Med. Inform.

    (1998)
  • Cited by (28)

    • The perception of medical professionals and medical students on the usefulness of an emergency medical card and a continuity of care report in enhancing continuity of care

      2011, International Journal of Medical Informatics
      Citation Excerpt :

      It is, therefore, critical that patients have access to adequate and effective data monitoring and communication mechanisms with their healthcare providers. Sharing of patient information by mail (e.g., via discharge letters) has been a traditional method for many years, but it has proved to be slow, inefficient and erroneous, and can potentially lead to poor quality of patient care [12,18,19]. A better technique is the adoption of an electronic medical record (EMR), which can enable multiple healthcare providers treating the same patient to efficiently share and use the patient's health information [20–22].

    View all citing articles on Scopus
    View full text