Q&A: Medical emoji may broaden health care communication

In a recent editorial, researchers encouraged the normalization of medical emoji across the health care community, with the intent of providing accessible and effective means of communication to patients in the digital age.

“It’s tempting to dismiss emoji as a millennial fad, the ‘textual equivalent of an adolescent grunt’,” the authors wrote. “But as a preloaded, curated, digital set of images that work across platforms — mobile, tablet, desktop; Windows, Apple iOS or Android — emoji possess the power of standardization, universality, and familiarity to users, with increasing usage in both informal and professional settings.”

In an interview with Healio Primary Care, coauthor Shuhan He, MD, an ED physician at Massachusetts General Hospital and an instructor of medicine at Harvard University, discussed how medical emoji can improve inclusivity in health care and broaden the health care professional’s toolkit when treating patients.

Healio Primary Care: How can physicians use medical emoji in practice? What are the pros and cons?

He: I think we are just starting to understand the implications of a non-trademarked, digital and universal visual language. Already, there are some obvious use cases — for instance, in places where we already use emoji-like visualizations such as the Wong-Baker FACES Scale, which is a pain scale that shows a series of faces ranging from a happy face at 0, or “no hurt,” to a crying face at 10, which represents “hurts like the worst pain imaginable.” Furthermore, because the technology is inherently digital, it allows a whole new world of possibilities, like being able to track real-world evidence and patient-reported outcomes on digital health technologies on a day-to-day, hour-to-hour, or event-by-event basis that was not possible with paper-based scales.

Healio Primary Care: In the paper, you wrote that you are “actively curating” a cohesive set of medical emoji. What emoji signs do you plan on including?

He: I believe there are really three categories of medical emoji that should be curated. First, it is critical for the medical establishment to understand that Unicode is a worldwide standards organization with its own criteria, including images that are iconic and not overly specific, so it is important that we abide by these criteria.

I do believe that three common classes of medical imagery should be included that can fit the Unicode criteria while simultaneously being important to the medical establishment:

• Type 1: Anatomically Correct Emoji, including the liver (with the gallbladder attached), kidney, intestines, spine and stomach.
• Type 2: Commonly used diagnostics that are also iconic medical emoji — EKG, CT scan and weight scale.
• Type 3: Commonly used treatments that are iconic — blood bag, IV bag, casted limb, pill box (to represent regularly scheduled medications) and pill pack (to represent regimented courses of antibiotics or suboxone).

Our current process is to work with medical societies with interest in these particular emoji and have them create formal recommendations on behalf of the patients and the missions in which they represent.

Healio Primary Care: After finalizing a set of medical emoji, what are the next steps?

He: I think this is work that is in parallel and not in series. We are actively studying multiple aspects of how patients interact with existing emoji in multiple practice settings while simultaneously advocating for more medical emoji. I do believe it is important that we maximize our evidence-based practice for specific subpopulations, the interpretations, and how it correlates to a specific pathology. As an example, we know that the English-language phrase “crushing substernal chest pain” is highly specific to acute coronary syndrome, and we want to be able to identify these sorts of correlates before we start utilizing them in an open-ended way.

Healio Primary Care: When do you predict medical emoji will be more widely used across the U.S.?

He: I believe that the implementation can be quite quick, given that we already use what are essentially paper-based emoji. The Wong-Baker Scale is a perfect example. [The Patient-Centered Outcomes Research Institute] and other institutions have been very interested in implementing patient-reported outcomes to move the United States health care system towards more accountable care type compensation models, so there is a strong incentive if we are able to use it to capture patient’s subjective data.

Healio Primary Care: Is there anything else that you’d like to add?

He: Emoji can be thought of as a visual language, similar to the Chinese language, and can convey lots of meaning. We are working to understand how this new evolving language can be used as a means to communicate, and with most languages, it changes over time and can have regional differences. The power of emoji is that it is universal, and so the question becomes how uniform the emoji language is compared to most other written languages, which are not necessarily universal.

Reference:

Lai D, et al. JAMA. 2021;doi:10.1001/jama.2021.8409.