Patient Use of Secure Electronic Messaging Within a Shared Medical Record: A Cross-sectional Study

ABSTRACTBACKGROUNDMost patients would like to be able to exchange electronic messages with personal physicians. Few patients and providers are exchanging electronic communications.OBJECTIVETo evaluate patient characteristics associated with the use of secure electronic messaging between patients and health care providers.DESIGN, SETTING, AND PATIENTSCross-sectional cohort study of enrollees over 18 years of age who were enrolled in an integrated delivery system in 2005.MEASUREMENTS AND MAIN RESULTSAmong 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).CONCLUSIONSIn 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.

[1]  K. Viswanath,et al.  Health disparities, communication inequalities, and eHealth. , 2007, American journal of preventive medicine.

[2]  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.

[3]  Rachel Akers,et al.  Parent and physician attitudes regarding electronic communication in pediatric practices. , 2002, Pediatrics.

[4]  Debra Revere,et al.  Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study , 2004, BMJ : British Medical Journal.

[5]  David Carrell,et al.  Research Paper: Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction , 2007, J. Am. Medical Informatics Assoc..

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

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

[8]  B Starfield,et al.  Ambulatory care groups: a categorization of diagnoses for research and management. , 1991, Health services research.

[9]  J C Wyatt,et al.  The origin, content, and workload of e-mail consultations. , 1998, JAMA.

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

[11]  Barbara Starfi.  Threads and Yarns: Weaving the Tapestry of Comorbidity , 2006 .

[12]  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.

[13]  David Carrell,et al.  Messages, Strands and Threads: Measuring Use of Electronic Patient-Provider Messaging , 2005, AMIA.

[14]  J. Ralston,et al.  Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. , 2008, JAMA.

[15]  James D. Ralston,et al.  Web-Based Collaborative Care for Type 2 Diabetes , 2009, Diabetes Care.

[16]  W. Kapoor,et al.  Redesigning the Practice Model for General Internal Medicine. A Proposal for Coordinated Care , 2007, Journal of general internal medicine.

[17]  David W. Bates,et al.  Opportunities to enhance patient and physician e-mail contact , 2003, Int. J. Medical Informatics.

[18]  Kenneth D. Mandl,et al.  Viewpoint Paper: Early Experiences with Personal Health Records , 2008, J. Am. Medical Informatics Assoc..

[19]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[20]  T. Houston,et al.  Patient Access to U.S. Physicians Who Conduct Internet or E-mail Consults , 2007, Journal of General Internal Medicine.

[21]  E. Rogers,et al.  Diffusion of innovations , 1964, Encyclopedia of Sport Management.

[22]  Terhilda Garrido,et al.  Patient access to an electronic health record with secure messaging: impact on primary care utilization. , 2007, The American journal of managed care.

[23]  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.

[24]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[25]  D M Steinwachs,et al.  Development and Application of a Population-Oriented Measure of Ambulatory Care Case-Mix , 1991, Medical care.

[26]  D. Ford,et al.  Doctors Who Are Using E-mail With Their Patients: a Qualitative Exploration , 2003, Journal of medical Internet research.

[27]  M. Von Korff,et al.  Chronic care costs in managed care. , 1997, Health affairs.

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

[29]  David M. Rind,et al.  Research Paper: Who Uses the Patient Internet Portal? The PatientSite Experience , 2006, J. Am. Medical Informatics Assoc..

[30]  D. A. Tong,et al.  Requests for medical advice from patients and families to health care providers who publish on the World Wide Web. , 1997, Archives of internal medicine.

[31]  Sherry Holcomb,et al.  Computer-using patients want Internet services from family physicians. , 2002, The Journal of family practice.