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Electronic Messaging Between Primary and Secondary Care

A Four-year Case Report

Affiliations of the authors: Erasmus University Rotterdam, The Netherlands (PWM, JvdL, PJB, WJvdK); Deloitte & Touche Bakkenist, Diemen, The Netherlands (PJB); Isala Klinieken, Zwolle, The Netherlands (WJvdK).

Correspondence and reprints: Peter W. Moorman, MD, PhD, Department of Medical Informatics, Room Ee2110, Medical Faculty, Erasmus University Rotterdam, P.O. Box 1738, 3000 Rotterdam, The Netherlands; e-mail: <moorman{at}mi.fgg.eur.nl>.

Received for publication: 08/03/00; accepted for publication: 02/28/01.

Objective: To observe how electronic messaging between a hospital consultant and general practitioners (GPs) in 15 practices about patients suffering from diabetes evolved over a 3-year period after an initial 1-year study.

Design: Case report. Electronic messages between a hospital consultant and GPs were counted. The authors determined whether a message sent by the consultant was integrated into the receiving GP's electronic medical record system. After the observation period, the GPs answered a questionnaire.

Measurements. The number of electronic messages and the percentage of messages integrated into the electronic medical record.

Results. The volume of messages was maintained during the 3 years after the original study. In the original study, the percentage of the messages integrated by the GPs increased during the year. After that study, however, seven GPs stopped integrating data from messages. The extent to which received messages were integrated varied widely among practices.

Conclusion. The authors conclude that extrapolation of the results of the original study would have led to incorrect conclusions. Although the volume of messages remained stable after the original study, GPs changed their method of handling messages. Initially, all GPs used the opportunity to copy data from the messages into their own records. At the end of the observation period (that is, the 3 years after completion of the original study), more than 50 percent of GPs had ceased copying data from the messages into their own records. The majority of GPs, however, wanted to expand the use of electronic messaging.

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