Table 1
Desiderata for Personal Clinical Electronic Communication
| Item | Sub-item | Median | Mean ± SD | Description |
| 1 | 5 | 5 ± 0.7 | Security/Reliability | |
| 1.1 | 5 | 4.9 ± 0.3 | Backups—Backups should be maintained such that adequate and effective recoverywill be efficient and accurate. | |
| 1.2 | 5 | 4.8 ± 0.4 | Audit Trail—A record should be kept of every time anyone writes, reads, forwards, or responds to a message. This should automatic, regardless of what record was record was accessed or by whom. | |
| 1.3 | 5 | 4.8 ± 0.4 | Encryption—All messages should be stored and transported in an appropriate manner such as to deter unwanted intrusion. | |
| 1.4 | 5 | 4.8 ± 0.4 | Security Policy—A formal security policy should be established and implemented. | |
| 1.5 | 5 | 4.8 ± 0.6 | Strong Authentication—Secure methods should be implemented such that authorization is restricted to appropriate users. This will include utilization of user password validation, and may also incorporate techniques such as digital signatures, cryptography, secureID, etc. | |
| 1.6 | 5 | 4.0 ± 1.3 | Digital Signature—Through the use of software tools, a digital “signature” should be used to sign every message indicating who the message is from. Every user will be assigned a unique encryption key, such as a large number carried on a smart card. This key is then used to uniquely identify any message that is sent by that person. | |
| 1.7 | 3.5 | 3.2 ± 1.9 | Automatic Timeout—The user interface should be such that a timeout mechanism is in place to prevent unwanted use due to negligence. | |
| 2 | 5 | 4.7 ± 0.5 | Cross Coverage—Communications should be in place such that any lack of response should be automatically forwarded to another caregiver so that the issue can be dealt with | |
| 3 | 5 | 4.65 ± 0.5 | E-mail Directing—The system should be able to direct messages to more than one addressee, identified as “To:” and “CC:,” in the message header. | |
| 4 | 4.8 | 4.35 ± 0.8 | Footprint/Thin Client—The communication system should not require any special software for accessing messages. Messages will be dealt with through commonly available applications such as a Web browser. | |
| 5 | 5 | 4.1 ± 1.2 | No SPAM—Unsolicited e-mails (SPAM) should be kept to a minimum. | |
| 6 | 4.5 | 4.0 ± 1.6 | Convenient—The user interface should be easy to use and not foreign to the users. | |
| 7 | 4 | 3.9 ± 1.0 | Copy-and-paste Features—The system should allow pasting from the Windows clipboard to facilitate the addition of pertinent information into a message. | |
| 8 | 3.5 | 3.7 ± 1.1 | Receipt System | |
| 8.1 | 4.5 | 3.9 ± 1.4 | Receipt Record—A record of whether the recipient has received an e-mail and responded to it in a timely fashion—i.e., a temporal tracking system with a reminder to the appropriate party (or parties)—will be important if the volume of messages is high. | |
| 8.2 | 3.5 | 3.7 ± 0.8 | Receipt Management System—There should be a centrally located system that maintains a record of the status of each message, such as whether the message has been “received,” “received and read,” or “read and responded.” | |
| 8.3 | 3.5 | 3.6 ± 1.2 | Acknowledgment—Senders should know that receivers have not only received but have read and responded to an e-mail. Acknowledgments need to be managed so that at any given time the status of all messages sent, whether read or not, can be seen. | |
| 9 | 3.5 | 2.9 ± 1.5 | Escalation | |
| 9.1 | 4 | 3.8 ± 1.0 | Triage/Automatic Escalation—Urgent items should be automatically routed to the appropriate person so that they can be processed in an expedited fashion. In the event of no response, the message should be sent to someone else, until the issue contained in the message is dealt with. | |
| 9.2 | 3 | 2.0 ± 1.9 | Due-date Escalation— As a particular date approaches, the level of priority increases proportionally. | |
| 10 | 3.5 | 3.4 ± 1.4 | Attachments—The system should be able to handle encoded attachments for file transfers between different entities. | |
| 11 | 4.5 | 3.4 ± 2.1 | Recipient Disclosure/No BCC (blind copying)—The system should not allow blind copies; all users to whom a message is sent to should be made known. | |
| 12 | 3.5 | 3.2 ± 1.6 | Alerting Reminders—The system should be able to individualize alerts and should have a reminder system on both the patient and the provider sides. | |
| 13 | 3 | 3.2 ± 1.0 | Group Addressing—The ability to send messages to various groups (such as all the patients of Dr. C) should be in place to create a more efficient atmosphere for communication. | |
| 14 | 3 | 2.9 ± 1.5 | Threading Multiple Messages of Same Case—This is the ability to have threaded messages, so that particular issues can be dealt with in a linear fashion. That is, when somone replies to a message, the reply is linked to the original message. This allows for ease in the review of related messages. | |
| 15 | 3 | 2.6 ± 1.3 | Structured Messaging | |
| 15.1 | 3 | 2.6 ± 1.3 | Beyond Standard Text—This is the ability to go beyond standard e-mail format, such as structured messaging. | |
| 15.2 | 3 | 2.6 ± 1.3 | Check Lists—Check lists give users options to respond to a query rather than write a narrative account. | |
| 16 | 2.5 | 2.3 ± 1.6 | Chat/Instant Communication—A feature of instant communication, possibly with other members of a health care team, in the care of a particular patient. | |
| 17 | 2 | 2.1 ± 1.2 | Calendaring—This function would assist in the scheduling of events by use of the messaging system. | |
| 18 | 1.8 | 1.4 ± 2.7 | Prioritization | |
| 18.1 | 3.5 | 2.2 ± 3.1 | Levels of Importance—Each message should be clearly established at a level of importance set by the user. | |
| 18.2 | 0 | 0.6 ± 2.2 | Priority Preservation—The priority of a sent message should maintain its level of given priority throughout a given thread | |
| 19 | 2 | 1.9 ± 2.0 | Separation of Roles—The accounts of certain persons should be maintained separately from accounts for their roles, to allow for the maintenance of better audit trails. | |
| 20 | 1 | 1.0 ± 1.7 | Asynchronous Alerting—A mechanism should be in place that gives notification out of band; e.g., a page is sent each time a message is received. | |
| 21 | 0.5 | 0.6 ± 2.2 | VIP Messaging—Messages of high importance should be given individual passwords to add another level of security. |
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NOTE: Features are ordered by mean score. When several features are grouped into a single item, the overall mean is used for ordering and sub-items ordered within the item.
