title: Crossing the digital divide: evaluating online communication between patients and their providers.
abstract: OBJECTIVE
  To address provider, payer, and patient concerns about the use of online communication in healthcare settings by performing a randomized controlled trial of a Web-based patient-provider communication tool in primary care.
  
  
  METHODS
  Forty-one staff physicians and 91 residents in 4 primary care centers were randomized to a Web-based online communication system. Patients of intervention physicians were encouraged to communicate via the system about health issues, scheduling, prescription renewals, referrals, and billing. Data collected included patient Web use, e-mail use, telephone calls, visit distribution, and physician and patient attitudes toward and satisfaction with communication.
  
  
  RESULTS
  One thousand thirty-eight patients sent 2238 messages during the 40-week study. Half of the messages were directly related to a patient's health; half were administrative. Patient Web use peaked at 8.5 weekly messages per 100 scheduled visits. Patient e-mail and telephone volume remained similar across groups. Intervention physicians reported more positive attitudes toward Web-based communication than control physicians (mean Web benefits scale score, 4.0 vs 1.1; P = .008), but there were no between-group differences in attitudes toward communication in general. Patients and physicians reported differential preferences for the use of online communication based on problem complexity and sensitivity.
  
  
  CONCLUSIONS
  Web-based messaging was lower than expected because of patient-related factors and limitations of the technology. Patients, physicians, and staff had positive attitudes toward online communication. There was no detectable difference in communication volume between study groups, but more sensitive measures of work burden need to be developed and evaluated.
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, 300 N Ingalls, Suite 7E12, Box 0429, Ann Arbor, MI 48109-0429, USA. skatz@umich.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.forename: Neil
authors.initials: N
authors.lastname: Nissan
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Moyer
mesh_terms: D003625:Data Collection; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*