Short message service or disService: issues with text messaging in a complex medical environment.
BACKGROUND
Hospitals today are experiencing major changes in their clinical communication workflows as conventional numeric paging and face-to-face verbal conversations are being replaced by computer mediated communication systems. In this paper, we highlight the importance of understanding this transition and discuss some of the impacts that may emerge when verbal clinical conversations are replaced by short text messages.


METHODS
In-depth interviews (n=108) and non-participatory observation sessions (n=260h) were conducted on the General Internal Medicine wards at five academic teaching hospitals in Toronto, Canada.


RESULTS
From our analysis of the qualitative data, we identified two major themes. De-contextualization of complex issues led to an increase in misinterpretation and an increase in back and forth messaging for clarification. Depersonalization of communication was due to less verbal conversations and face-to-face interactions and led to a negative impact on work relationships.


CONCLUSIONS
Text-based communication in hospital settings led to the oversimplification of messages and the depersonalization of communication. It is important to recognize and understand these unintended consequences of new technology to avoid the negative impacts to patient care and work relationships.
Centre of Innovation in Complex Care, University Health Network, Toronto, ON, Canada; Department of General Internal Medicine, University Health Network, Toronto, ON, Canada. Electronic address: Robert.wu@uhn.ca.
Robert
R
Wu
Centre of Innovation in Complex Care, University Health Network, Toronto, ON, Canada; Department of Communication and Information, Rutgers University, New Brunswick, NJ, USA.
Lora
L
Appel
Trillium Health Partners, Mississauga, ON, Canada.
Dante
D
Morra
Centre of Innovation in Complex Care, University Health Network, Toronto, ON, Canada.
Vivian
V
Lo
Office of Continuing Education and Professional Development, University of Toronto, ON, Canada; Li Ka-Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
Simon
S
Kitto
Trillium Health Partners, Mississauga, ON, Canada.
Sherman
S
Quan
D040421:Cell Phone / Q000706:statistics & numerical data*; D003142:Communication; D003695:Delivery of Health Care; D006282:Health Personnel; D006784:Hospitals, Teaching; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007400:Interprofessional Relations; D005791:Patient Care; D036301:Qualitative Research; D060145:Text Messaging / Q000706:statistics & numerical data*
Email; Hospital communication system; Interprofessional communication; Smartphones