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In one hospital's secure clinical texting system, emojis and emoticons were primarily used to share new information or convey added meaning, suggesting that concerns about the professionalism of their use may be unfounded, according to a qualitative study.

Within a sample of over 1,300 threads among 80 hospitalists who sent messages using a clinical texting system at a large Midwestern hospital, emojis or emoticons were used emotively in 61% of cases, and 32% served to start, maintain, or finish a conversation, reported Colin Halverson, PhD, of the Indiana University School of Medicine in Indianapolis, and co-authors.

Overall, there was no evidence that use of these emojis or emoticons led to any confusion or were considered inappropriate by the user who received the message, they noted in .

"Clinicians are using emoji [and] emoticons, but they do not appear to be using them in ways that other writers have worried about," Halverson told 番茄社区app. "For instance, they appear to disambiguate rather than cause confusion. They add information rather than appear purely decorative, humorous, or playful, and they do not appear to be taken up as unprofessional by recipients."

"More research is warranted, but our data suggest that emoji [and] emoticons are generally used in prosocial ways, in commiserating, building interprofessional relationships, clarifying attitudes, and softening the impact of demands [or] requests," he added.

In an , Shuhan He, MD, of Massachusetts General Hospital in Somerville, and co-authors agreed that emojis have the potential to improve and further clarify communication between clinicians, their patients, and their colleagues.

"This research carries important implications, as it suggests that emoji and emoticons are crucial in professional medical communication," they wrote.

They also suggested that use of emojis in healthcare messaging has several advantages, such as universal appeal. However, they recommended that a universal emoji-based language system be adopted by major medical societies to facilitate the appropriate widespread use of emojis in clinical messaging.

"As digital health technology continues to advance, embracing the potential of emoji as a language for health can substantially enhance communication, ultimately improving patient care," they concluded.

For this qualitative analysis, Halverson and team analyzed 1,319 messaging threads sent to or from 80 hospitalists at one Midwestern U.S. hospital from July 2020 through March 2021. They selected a random subset of 1% of the 129,360 message threads exchanged in a secure clinical messaging platform with those selected hospitalists, who were chosen because of their high use of the messaging system.

Of the 80 hospitalists included in the analysis, 61% were men, 53% were white, and 37% were Asian. Of the 41 with available age data, 32% were ages 25-34, and 46% were 35-44.

Of note, just 7% of the 1,319 sample messaging threads contained at least one emoji or emoticon.

The researchers defined emojis as 12×12 pixel images of anything from a smiley face to a fruit, and emoticons as representations of faces made using text characters from a traditional keyboard, such as a :).

The most commonly used emojis included the thumbs-up (39%), the smiley face (9%), the tears of joy face (6%), and the heart (5%).

While the findings highlighted unique insights into emoji and emoticon use, Halverson and colleagues acknowledged the limited scope of the data, which was collected at a single academic medical center. They also noted that clinicians in other healthcare settings could have different norms and practices around the use of emojis and emoticons for clinical messaging.

The authors suggested that further research should be done to understand clinicians' perception of ideograms to help determine best practices for their use in medicine.

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