Information can be categorised according to its level of privacy [1
]. Boyne's model consists of three categories or levels: Level C: information relevant to all humans, often found in theoretical exposition like in textbooks. Level B: information relevant to on a subcategory of humans, e.g. patients with breast cancer; often communicated via scientific articles and, increasingly, via the Internet. Level A: information relevant to on a specific patient, e.g. the results of mammogram; often kept in healthcare record systems. Hyperlinks may be used to link information that belongs together because it addresses the same topic, but which is separated for reasons of privacy.
Information is essential in healthcare. Recording, handling and sharing healthcare information is important in order to ensure high quality of delivered healthcare [2
]. Some diseases and especially cancer pathways are complicated trajectories that involve multiple actors. This calls for continuously updated information and well-functioning communication channels to ensure due coordination, integration, effectiveness and shared decision-making. In Denmark, the general practitioner (GP) plays an important role in the patients' cancer pathways [3
], not least because the GP serves as a gatekeeper to specialised healthcare. About 98% of Danish citizens are listed with a specific GP[4
Information and communication technology (ICT) is often used for communication and information exchange purposes [5
]. This purpose may be served by deploying a centralized strategy that resorts to web-based ICT; or by deploying a decentralized strategy that makes use of software installed in each healthcare provider's local setting. Contrary to web-based resources, locally installed ICT tools require GP resources for installation and maintenance [6
]. On the other hand, the current information overload on the Internet makes web-based solutions a less attractive option than locally installed tools [7
Danish GPs have been using electronic medical records for decades and electronic record coverage has now reached 100% [8
]. The Danish non-profit organisation MEDCOM has developed nation-wide standards for the most frequent cross-sector communication flows in the health care sector [10
]. These standards are based on the United Nations Electronic Data Interchange for Administration, Commerce and Transport (EDIFACT) standard [11
]. A secured network, the Healthcare Data Network, connects providers in primary and secondary care and enables confidential and encrypted data exchange.
After every in- or out-patient contact with a hospital an electronic discharge summary letter is sent to the patient’s GP. Furthermore, when a GP orders an x-ray, blood tests or microbial analysis, the results are automatically returned electronically to the GP. Such discharge letters and test result communication (Level A information) enable the GP to coordinate further care.
The present paper hypothesizes that using hyperlinks inserted into the electronic communication (Level A information) may be a useful method for increasing access to existing, patient-oriented information with general information about the disease and its treatment via the web (Level B information).
Hence, the aim was to test this hypothesis by examining to which extent a hyperlink inserted into mammography test result communication to the GPs is actually being utilized by the GPs. First, we compared the use of web-addresses in paper information letters with the use of hyperlinks in electronic test result communication. Second, we investigated whether the GP’s gender, age or attitude towards mammography screening modified his or her use of the hyperlink. Finally, we analysed if priming the GPs with e-mails enhanced their use of hyperlinks.