title: Secure web messaging in a pediatric chronic care clinic: a slow takeoff of "kids' airmail".
abstract: BACKGROUND
  Although e-mail may be an efficient clinician-patient communication tool, standard e-mail is not adequately secure to meet Health Insurance Portability and Accountability Act (HIPAA) guidelines. For this reason, firewall-secured electronic messaging systems have been developed for use in health care. Impact and usability of these secure systems have not been broadly assessed.
  
  
  OBJECTIVE
  To evaluate the impact of a secure electronic messaging system implemented for a pediatric subspecialty clinic.
  
  
  METHODS
  This study was performed in an outpatient, academic pediatric respiratory clinic in spring 2009 in New Haven, Connecticut. Patients were surveyed prior to implementation regarding internet usage. The Kryptiq messaging system was implemented and messages were monitored continuously and tracked. Open-ended qualitative interviews with 28 users and nonusers were conducted, and we described the process of implementation.
  
  
  RESULTS
  All of the 127 patients/families surveyed expressed interest in using the Internet to contact their clinic providers, and they all reported having the ability to access the Internet. In the 8 months after implementation, only 5 messages were initiated by patients in contrast to 2363 phone calls. Themes emerged from the open-ended interviews that indicated promoters, barriers, and potential uses. Prominent barriers included the lack of convenience and personal touch and being technically difficult to use.
  
  
  CONCLUSIONS
  Although these patients/families expressed strong interest in e-mailing, secure Web messaging was less convenient than using the phone, too technically cumbersome, lacked a personal touch, and was used only by a handful of patients.
authors.affiliation: Department of Pediatrics, Yale School of Medicine, New Haven,Connecticut, USA. allen.hsiao@yale.edu
authors.forename: Allen L
authors.initials: AL
authors.lastname: Hsiao
authors.forename: Alia
authors.initials: A
authors.lastname: Bazzy-Asaad
authors.forename: Concettina
authors.initials: C
authors.lastname: Tolomeo
authors.forename: Diana
authors.initials: D
authors.lastname: Edmonds
authors.forename: Beverly
authors.initials: B
authors.lastname: Belton
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Benin
mesh_terms: D002648:Child; D002908:Chronic Disease; D016494:Computer Security / Q000941:ethics / Q000592:standards*; D003219:Confidentiality / Q000941:ethics / Q000592:standards*; D003625:Data Collection / Q000379:methods; D034742:Electronic Mail / Q000941:ethics / Q000592:standards*; D006801:Humans; D020407:Internet / Q000941:ethics / Q000592:standards; D010044:Outpatient Clinics, Hospital / Q000941:ethics / Q000592:standards*; D010817:Physician-Patient Relations / Q000941:ethics; D013997:Time Factors