Use of e-Health services between 1999 and 2002: a growing digital divide.

OBJECTIVE To evaluate the patterns of e-Health use over a four-year period and the characteristics of users. DESIGN Longitudinal, population-based study (1999-2002) of members of a prepaid integrated delivery system. Available e-Health services included ordering prescription drug refills, scheduling appointments, and asking medical questions. MEASUREMENTS Rates of known access to e-Health services, and of e-Health use each quarter. RESULTS The number of members with known e-Health access increased from 51,336 (1.6%) in 1999 to 324,522 (9.3%), in 2002. The percentage of households in which at least one person in the household had access increased from 2.7% to 14.1%. Among the subjects with known access, the percentage of subjects that used e-Health at least once increased from 25.7% in 1999 to 36.2% in 2002. In the multivariate analysis, subjects who had a low expected clinical need, were nonwhite, or lived in low socioeconomic status (SES) neighborhoods were less likely to have used e-Health services in 2002. Disparities by race/ethnicity and SES persisted after controlling for access to e-Health and widened over time. CONCLUSION Access to and use of e-Health services are growing rapidly. Use of these services appears to be greatest among persons with more medical need. The majority of subjects, however, do not use any e-Health services. More research is needed to determine potential reasons for disparities in e-Health use by race/ethnicity and SES as well as the implications of these disparities on clinical outcomes.

[1]  L. Baker,et al.  Use of the Internet and e-mail for health care information: results from a national survey. , 2003, JAMA.

[2]  E. B. Steen,et al.  The Computer-Based Patient Record: An Essential Technology for Health Care , 1992, Annals of Internal Medicine.

[3]  Kenneth Mandl,et al.  Electronic Patient-Physician Communication: Problems and Promise , 1998, Annals of Internal Medicine.

[4]  I S Kohane,et al.  Growth and determinants of access in patient e-mail and Internet use. , 2000, Archives of pediatrics & adolescent medicine.

[5]  E. Murray,et al.  The impact of health information on the internet on the physician-patient relationship: patient perceptions. , 2003, Archives of internal medicine.

[6]  J. Goldsmith,et al.  The Internet and managed care: a new wave of innovation. , 2000, Health affairs.

[7]  Donna L. Hoffman,et al.  Bridging the Digital Divide: The Impact of Race on Computer Access and Internet Use. , 1998 .

[8]  T. Ferguson,et al.  Digital doctoring--opportunities and challenges in electronic patient-physician communication. , 1998, JAMA.

[9]  D. Gustafson,et al.  An Evidence-Based Approach to Interactive Health Communication: A Challenge to Medicine in the Information Age , 1998 .

[10]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[11]  N. Krieger.  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. , 1992, American journal of public health.

[12]  H. Collard,et al.  Demystifying idiopathic interstitial pneumonia. , 2003, Archives of internal medicine.

[13]  Steven J Katz,et al.  Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. , 2002, The American journal of managed care.

[14]  T. Bodenheimer,et al.  Electronic technology: a spark to revitalize primary care? , 2003, JAMA.

[15]  T N Robinson,et al.  An evidence-based approach to interactive health communication: a challenge to medicine in the information age. Science Panel on Interactive Communication and Health. , 1998, JAMA.

[16]  J. Mcconnaughey.  Falling through the net II: New data on the digital divide , 1998 .

[17]  S. Dufour.  I: Commerce , 2001, Canadian Yearbook of international Law/Annuaire canadien de droit international.

[18]  D H Gustafson,et al.  Access to health information and support: a public highway or a private road? , 1998, JAMA.

[19]  D. Bates,et al.  Using Diagnoses to Describe Populations and Predict Costs , 2000, Health care financing review.

[20]  Joshua Fogel,et al.  Use of the Internet by Women with Breast Cancer , 2002, Journal of medical Internet research.

[21]  Steven J Katz,et al.  Effect of a triage-based e-mail system on clinic resource use and patient and physician satisfaction in primary care , 2003, Journal of general internal medicine.

[22]  Marcy M. Allen,et al.  The Ever-Shifting Internet Population: A New Look At Internet Access and the Digital Divide, Amanda Lenhart (Ed.). The Pew Internet & American Life Project, Washington, DC (2003) , 2005, Gov. Inf. Q..

[23]  J Z Ayanian,et al.  Measuring population health risks using inpatient diagnoses and outpatient pharmacy data. , 2001, Health services research.

[24]  R. Blendon,et al.  Health information, the Internet, and the digital divide. , 2000, Health affairs.