BACKGROUND
Most patients would like to be able to exchange electronic messages with personal physicians. Few patients and providers are
exchanging electronic communications.
OBJECTIVE
To evaluate patient characteristics associated with the use of secure electronic messaging between patients and health care
providers.
DESIGN, SETTING, AND PATIENTS
Cross-sectional cohort study of enrollees over 18 years of age who were enrolled in an integrated delivery system in 2005.
MEASUREMENTS AND MAIN RESULTS
Among eligible enrollees, 14% (25,075) exchanged one or more secure messages with a primary or specialty care provider between
January 1, 2004 and March 31, 2005. Higher secure messaging use by enrollees was associated with female gender (OR, 1.15;
95% CI, 1.10–1.19), greater overall morbidity (OR, 5.64; 95% CI, 5.07–6.28, comparing high or very high to very low overall
morbidity), and the primary care provider’s use of secure messaging with other patients (OR, 1.94; 95% CI, 1.67–2.26, comparing
20–50% vs. ≤10% encounters through secure messaging). Less secure messaging use was associated with enrollee age over 65 years
(OR, 0.65; CI, 0.59–0.71) and Medicaid insurance vs. commercial insurance (OR, 0.81; 95% CI, 0.68–0.96).
CONCLUSIONS
In this integrated group practice, use of patient–provider secure messaging varied according to individual patient clinical
and sociodemographic characteristics. Future studies should clarify variation in the use of electronic patient–provider messaging
and its impact on the quality and cost of care received.
KEY WORDS physician–patient relations - electronic mail - healthcare disparities
Funding Sources This study was funded by the Agency for Health Care Research and Quality (Grant No. R03 HS014625–01).
Human Subjects Protections Review and Approval This study was reviewed and approved by the Group Health Center for Health Studies Institutional Review Board.