Collaborative writing applications to support the implementation of best practices in healthcare.

What is the aim of this review?

The aim of this Cochrane review was to find out whether collaborative writing applications (CWAs), also known as collaborative writing tools, could improve the way health professionals work, and improve patients’ health. Another goal of our study was to examine the costs and resources needed to use CWAs. Finally, we wanted to know if certain CWA features (for example, being open, like Wikipedia, versus being closed, like the Canadian CPOE toolkit), and different clinical practice change factors (for example, the presence of a moderator) increased the CWAs' impact on healthcare. We searched for studies to answer these questions.

Key messages

We did not identify any studies that measured the effect of CWAs on how healthcare professionals care for their patients.

What was studied in this review?

When people receive healthcare, it is important that they are treated according to best practices. However, decision makers, health professionals, researchers, and patients need tools to support best practices. Collaborative writing applications are a new category of information and communication technologies that allow multiple individuals to share, create, and revise online documents at the same time. They could help implement best practices in healthcare. Collaborative writing applications could also help adapt online documents to local contexts. This could help reduce duplication and waste of resources. The most widely known example of a CWA is Wikipedia, the online encyclopaedia. However, there are many other examples of CWAs (e.g. WikEM, WikiDoc, Canadian CPOE toolkit, WikiTrauma). Despite the fact that CWAs are promising tools, it is not yet known if they improve how healthcare professionals care for their patients.

What are the main results of the review?

We searched 14 scientific bibliographic databases, two trial registries, and grey literature sources. We also contacted 106 authors and experts in the field to ask for relevant papers. No studies met our eligibility criteria; two potentially relevant studies are ongoing.

How up to date is this review?

We searched for evidence to August 2016.

Authors' conclusions: 

While there is a high number of published studies about CWAs, indicating that this is an active field of research, additional studies using rigorous experimental designs are needed to assess their impact and cost-effectiveness on process and patient outcomes.

Read the full abstract...

Collaborative writing applications (CWAs), such as wikis and Google Documents, hold the potential to improve the use of evidence in both public health and healthcare. Although a growing body of literature indicates that CWAs could have positive effects on healthcare, such as improved collaboration, behavioural change, learning, knowledge management, and adaptation of knowledge to local context, this has never been assessed systematically. Moreover, several questions regarding safety, reliability, and legal aspects exist.


The objectives of this review were to (1) assess the effects of the use of CWAs on process (including the behaviour of healthcare professionals) and patient outcomes, (2) critically appraise and summarise current evidence on the use of resources, costs, and cost-effectiveness associated with CWAs to improve professional practices and patient outcomes, and (3) explore the effects of different CWA features (e.g. open versus closed) and different implementation factors (e.g. the presence of a moderator) on process and patient outcomes.

Search strategy: 

We searched CENTRAL, MEDLINE, Embase, and 11 other electronic databases. We searched the grey literature, two trial registries, CWA websites, individual journals, and conference proceedings. We also contacted authors and experts in the field. We did not apply date or language limits. We searched for published literature to August 2016, and grey literature to September 2015.

Selection criteria: 

We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, and repeated measures studies (RMS), in which CWAs were used as an intervention to improve the process of care, patient outcomes, or healthcare costs.

Data collection and analysis: 

Teams of two review authors independently assessed the eligibility of studies. Disagreements were resolved by discussion, and when consensus was not reached, a third review author was consulted.

Main results: 

We screened 11,993 studies identified from the electronic database searches and 346 studies from grey literature sources. We analysed the full text of 99 studies. None of the studies met the eligibility criteria; two potentially relevant studies are ongoing.