Journal of General Internal Medicine

, Volume 28, Issue 7, pp 914–920

Access, Interest, and Attitudes Toward Electronic Communication for Health Care Among Patients in the Medical Safety Net

  • Adam Schickedanz
  • David Huang
  • Andrea Lopez
  • Edna Cheung
  • C. R. Lyles
  • Tom Bodenheimer
  • Urmimala Sarkar
Original Research

DOI: 10.1007/s11606-012-2329-5

Cite this article as:
Schickedanz, A., Huang, D., Lopez, A. et al. J GEN INTERN MED (2013) 28: 914. doi:10.1007/s11606-012-2329-5



Electronic and internet-based tools for patient–provider communication are becoming the standard of care, but disparities exist in their adoption among patients. The reasons for these disparities are unclear, and few studies have looked at the potential communication technologies have to benefit vulnerable patient populations.


To characterize access to, interest in, and attitudes toward internet-based communication in an ethnically, economically, and linguistically diverse group of patients from a large urban safety net clinic network.


Observational, cross-sectional study


Adult patients (≥ 18 years) in six resource-limited community clinics in the San Francisco Department of Public Health (SFDPH)


Current email use, interest in communicating electronically with health care professionals, barriers to and facilitators of electronic health-related communication, and demographic data—all self-reported via survey.


Sixty percent of patients used email, 71 % were interested in using electronic communication with health care providers, and 19 % reported currently using email informally with these providers for health care. Those already using any email were more likely to express interest in using it for health matters. Most patients agreed electronic communication would improve clinic efficiency and overall communication with clinicians.


A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers. This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging. Tools such as email encounters and electronic patient portals should be implemented and supported to a greater extent in resource-poor settings, but this will require tailoring these tools to patients’ language, literacy level, and experience with communication technology.


health information technology disparities clinical communication electronic patient portal 

Supplementary material

11606_2012_2329_MOESM1_ESM.doc (60 kb)
ESM 1(DOC 60 kb)

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Adam Schickedanz
    • 1
  • David Huang
    • 2
  • Andrea Lopez
    • 3
  • Edna Cheung
    • 4
  • C. R. Lyles
    • 3
  • Tom Bodenheimer
    • 5
  • Urmimala Sarkar
    • 3
  1. 1.Department of PediatricsUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Internal MedicineUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Center for Vulnerable Populations at San Francisco General Hospital, Department of Internal MedicineUniversity of California San FranciscoSan FranciscoUSA
  4. 4.University of California at BerkeleyBerkeleyUSA
  5. 5.Department of Family and Community MedicineUniversity of California San FranciscoSan FranciscoUSA

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