Journal of General Internal Medicine

, Volume 18, Issue 9, pp 736–744 | Cite as

Effect of a triage-based e-mail system on clinic resource use and patient and physician satisfaction in primary care

A randomized controlled trial
  • Steven J. KatzEmail author
  • Cheryl A. Moyer
  • Douglas T. Cox
  • David T. Stern
Innovations In Education And Clinical Practice


OBJECTIVES: E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care.

DESIGN AND PATIENTS/PARTICIPANTS: Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication.

RESULTS: E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P<.01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P=.45) or rates of patient no-shows (5% in both groups; P=.77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general.

CONCLUSIONS: E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians’ attitudes toward electronic communication were improved, but physicians’ and patients’ attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care.

Key words

e-mail utilization primary care on-line communication patient-provider communication 


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  1. 1.
    Ball M, Lillis J. E-health: transforming the physician/patient relationship. Int J Med Inf. 2001;61:1–10.CrossRefGoogle Scholar
  2. 2.
    Starr P. Health care reform and the new economy. Health Aff. 2000;19:23–32.CrossRefGoogle Scholar
  3. 3.
    Kassirer J. Patients, physicians, and the Internet. Health Aff. 2000;19:115–23.CrossRefGoogle Scholar
  4. 4.
    Cole JI, Suman M, Schramm P, et al. The UCLA Internet Report. Surveying the Digital Future. Year Two, 2001. Available at: Accessed June 25, 2003.Google Scholar
  5. 5.
    The Harris Poll. Patient/physician online communication: many patients want it, would pay for it, and it would influence their choice of doctors and health plans. Harris Interactive Health Care News. 2002;2:1–4.Google Scholar
  6. 6.
    Sittig D, King S, Hazlehurst B. A survey of patient-provider e-mail communication: What do patients think? Int J Med Inf. 2001;61:71–80.CrossRefGoogle Scholar
  7. 7.
    Moyer C, Stern D, Katz S, Fendrick A. We got mail: electronic communication between physicians and patients. Am J Manag Care. 1999;5:1513–22.PubMedGoogle Scholar
  8. 8.
    Moyer C, Stern D, Dobias K, Cox D, Katz S. Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. Am J Manag Care. 2002;8:427–33.PubMedGoogle Scholar
  9. 9.
    Kleinke J. the failed promise of the health care Internet. Health Aff. 2000;19:57–71.CrossRefGoogle Scholar
  10. 10.
    Baur C. Limiting factors on the transformative powers of e-mail in patient-physician relationships: a critical analysis. Health Commun. 2000;12:239–59.PubMedCrossRefGoogle Scholar
  11. 11.
    Goldsmith J. The Internet and managed care: A new wave of innovation. Health Aff. 2000;19:42–56.CrossRefGoogle Scholar
  12. 12.
    Anema MG, Brown BE. Increasing survey responses using the total design method. J Contin Educ Nurs. 1995;26:109–14.PubMedGoogle Scholar
  13. 13.
    Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD, for the Institute for Ethics AMACIU. The relationship between method of physician payment and patient trust. JAMA. 1998;280:1708–14.PubMedCrossRefGoogle Scholar
  14. 14.
    White C, Moyer C, Stern D, Cox D, Katz S. A content analysis of e-mail communication between patients and their providers: patients get the message. J Gen Intern Med. 2002;17(suppl):245.Google Scholar
  15. 15.
    Prady S, Norris D, Lester J, Hoch D. Expanding the guidelines for electronic communication with patients: application to a specific tool. J Am Med Inform Assoc. 2001;8:344–8.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Steven J. Katz
    • 1
    • 2
    • 4
    Email author
  • Cheryl A. Moyer
    • 2
  • Douglas T. Cox
    • 1
    • 2
    • 3
  • David T. Stern
    • 1
  1. 1.the Veterans Affairs Ann Arbor Healthcare SystemMichigan Collaborative for Health InformaticsUSA
  2. 2.the Division of General MedicineMichigan Collaborative for Health InformaticsUSA
  3. 3.Department of Internal MedicineUniversity of MichiganAnn Arbor
  4. 4.Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn Arbor

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