title: Early experiences with e-health services (1999-2002): promise, reality, and implications.
abstract: BACKGROUND
  E-health services may improve the quality and efficiency of care; however, there is little quantitative data on e-health use.
  
  
  OBJECTIVE
  The objective of this study was to examine trends in e-health use and user characteristics.
  
  
  METHODS
  This was a longitudinal study of e-health use (1999-2002) within an integrated delivery system (IDS). We classified 4 e-health services into transactional (drug refills and appointment scheduling) and care-related (medical and medication advice) services.
  
  
  METHODS
  Approximately 3.3 million members of a large, prepaid IDS.
  
  
  METHODS
  Amount and frequency of e-health use over time and characteristics of users.
  
  
  RESULTS
  The number of members registered for access to e-health increased from 20,617 (0.7% of all members) in Q1 1999 to 270,987 (8.6%) in Q3 2002. Between Q1 and Q3 2002, 42,845 members (1.3%) used the drug refill service and 55,901 (1.7%) used the appointment scheduling service compared with 10,756 members (0.3%) who used the medical advice service and 3069 (0.1%) who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses/user versus 1.6 uses/user among care-related service users. Members most likely to use e-health services had a high level of clinical need, a regular primary care provider, were 30 to 64 years old, female, white, and lived in a nonlow socioeconomic status neighborhood. These findings were consistent across e-health service types.
  
  
  CONCLUSIONS
  Although use of all e-health services grew rapidly, use of care-related services lagged significantly behind use of transactional services. Subjects with greater clinical need and better ties to the health system were more likely to use both types of e-health services.
authors.affiliation: Kaiser Permanente Medical Care Program, Division of Research, Oakland, California 94612, USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ortiz
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.forename: Bruce
authors.initials: B
authors.lastname: Fireman
authors.forename: Robert
authors.initials: R
authors.lastname: Miller
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Selby
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D002140:California; D002648:Child; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007255:Information Services / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008875:Middle Aged; D015999:Multivariate Analysis; D010593:Pharmaceutical Services / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000706:statistics & numerical data* / Q000639:trends*