title: Patient use of secure electronic messaging within a shared medical record: a cross-sectional study.
abstract: 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.
  
  
  METHODS
  Cross-sectional cohort study of enrollees over 18 years of age who were enrolled in an integrated delivery system in 2005.
  
  
  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. <or=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.
authors.affiliation: Group Health Cooperative, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448, USA. Ralston.j@ghc.org
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.forename: David
authors.initials: D
authors.lastname: Carrell
authors.forename: Julia
authors.initials: J
authors.lastname: Hecht
authors.forename: David
authors.initials: D
authors.lastname: Rubanowice
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D016017:Odds Ratio; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult