Email deliverability

We often receive queries regarding emails sent via Mediref and whether they have gone through to the recipient or not (especially in cases where the recipient claims not to have received the emails). This diagram/article goes over what an email journey looks like:

Mediref's role in sending out emails:

  1. Mediref can only guarantee that emails were actually sent out by our server. Beyond that, control of an email is out of our hands (more information below).
  2. The recipient server can (but does not always), relay a message back to our servers regarding the status of an email (more info below). If it does, and the email status points to the recipient not having received the email, Mediref will automatically generate a notification to let you know of this fact.

Possible email statuses:

  1. Sent and delivered successfully - self-explanatory - email delivered to the recipient inbox! Note - Delivered does not equal read. We have seen far too many cases of emails getting smothered in overflowing inboxes (not that there is anything you can do about it!).
  2. Spam - The recipient email client decided that Mediref's notification is a spam email and marked it as such. 
  3. The recipient email server 'bounces' the email. This can take two shapes:
    1. A hard bounce - E.g. If the email address has a typo and doesn't exist - Provided that the recipient email server relays this back to Mediref, we will notify you of this, allowing you to resend to a different email address.
    2. A soft bounce - E.g. If the email inbox is full and does not have space to receive any more emails. We will notify you as well as keep trying to deliver the email for three more days.
  4. Blocked by the recipient server - E.g. If they have a firewall and Mediref gets caught up in it. We will relay this back to you IF Mediref's server is made aware by the recipient server. Unfortunately, this does not always happen.

What to do if a recipient is claiming not to receive email notifications:

  1. Ask them to check their spam folder. 
  2. Ask then to do a mailbox search for 'Mediref' - we have come across many instances where email notifications have simply been missed/not been acted upon before they got drowned out by newer incoming email.
  3. If the above two fail and the email seems to have been swallowed up by the internet (i.e status 3/4 above, that has not been reported back to the Mediref server), then this is a conversation that they will need to have with their IT and/or their email service provider because chances are that legitimate emails are getting filtered out before reaching their inbox.

Note - You are welcome to contact us to double check whether an email notification has been sent out. Let us know the recipient email address in question and we can check it for you. However, to date, every single instance we have investigated in the past 3+ years has been a case of one of the above three scenarios.

Take-home summary:

  1. Mediref guarantees that emails will be sent out. Our control beyond that is limited. If an email fails and our servers are made aware of this, then you will automatically be notified (via an email to you as well as a red mark on your dashboard).
  2. In an ideal scenario, all recipients will be on Mediref so that delivery of patient correspondence is not reliant on the email protocol.

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