The strong drive to incorporate email consultations into routine clinical practice should proceed on the basis of secure evidence. As this field is still in its infancy, the research agenda covers all aspects of email communication in health care. This needs to begin with a detailed understanding of patient and professional preferences for modes of communication and why; an appreciation of how email consulting can best be integrated with other modes of consulting; the influence of email consulting on the patient-doctor relationship (for example, clinicians may be more defensive and patients consult for more trivial problems than in traditional consultations); identification of populations most likely to benefit from email communication; and understanding of safety, training, security, and interface issues.
Box 2: Potential disadvantages of email use in delivering health care
- May widen social disparities by allowing preferential access to wealthier people and young middle class adults
- Like other forms of written communication (such as letters and faxes), email does not easily provide the subtle emotive cues often gleaned from vocal intonation and physical demeanour that aid interpretation. Scope for non-verbal communication is currently very limited
- Inability to examine the patient
- Inability to use touch in the clinical encounter
- May increase the risk of diagnostic or communication errors
- Potential slow responses to messages that might require emergency actions
- Threats to patient privacy (including unauthorised interception of unencrypted emails, receipt or retrieval of emails by unauthorised people, inappropriate physical security measures)
- Providers may be overwhelmed by the volume and length of emails
About 60% of the UK population now has access to email, and its use is increasing rapidly worldwide
Email consultations have the potential to play an important role in delivery of preventive health care and in facilitating self management of chronic disorders
There is little evidence yet from controlled clinical trials that this potential benefit can be translated into routine clinical care
Successful communication by email depends on a clear and shared understanding by patient and healthcare professionals of its role, advantages, and limitations
Questions such as how clinicians can be patient centred in email consultations require innovative approaches to researching consultations that place emphasis on semantics (as written words are the sole conveyors of information). Because of the intricate ways in which email combines human communication and information communication technology, interdisciplinary research is essential.
We know that a large part of a verbal message's impact derives from the communication style and the clinician's “image” and appearance rather than the content. Will the user interface and the application's functionality (that is, the program design and layout) take this role in email consultations and become a critical element in the human-computer-human interaction? Examples of questions about interface design include, “Should different interfaces be used for different populations considering factors such as age, preferred language, and (computer) literacy?”
As email consulting increases, we need to ensure that those without email access to care are not unduly disadvantaged (see and box 2). Mechanisms for ensuring equitable access to care for sections of the population who do not use email are essential.
Use of internet and email among UK adults by income (households divided into tenths according to gross income). Use is concentrated in higher income groups. (Data source: National Statistics Omnibus Survey 2003)