Journal of General Internal Medicine

, Volume 19, Issue 9, pp 978–983 | Cite as

The emerging role of online communication between patients and their providers

  • Steven J. KatzEmail author
  • Cheryl A. Moyer


Despite the explosion of online communication in the community, its use between patients and their health care providers remains low. However, rapidly growing patient and provider interest in using online communication has motivated organizations to consider options for deploying these new tools in clinical practice. In this paper, we describe the barriers and challenges health care providers and their organizations must address in developing and deploying these new tools. We formulate lessons from early experiences with e-mail and web-based communication in clinical settings. Finally, we provide a roadmap for developing and deploying these new tools in clinical practice. Health care providers and their organizations will need to consider issues related to technology, data management, operations, communication management, and financial support in order to successfully deploy online services and communication for patients in clinical settings.

Key words

online communication medical costs quality 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Stange KC, Zysanski SJ, Jaen CR, et al. Illuminating the “black box.” A description of 4,454 patient visits to 138 family physicians. J Fam Pract. 1998;46:377–89.PubMedGoogle Scholar
  2. 2.
    Lin CT, Albertson GA, Schilling LM, et al. Is patients’ perception of time spent with the physician a determinant of ambulatory patient satisfaction? Arch Intern Med. 2001;161:1437–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Bower P, Roland M, Campbell J, Mean N. Setting standards based on patients’ views on access and continuity: secondary analysis of data from the general practice assessment survey. BMJ. 2003;326:258.PubMedCrossRefGoogle Scholar
  4. 4.
    Stevenson K, Ion V, Merry M, Sinfield P. Primary care. More than words. Health Serv J. 2003;113:26–8.PubMedGoogle Scholar
  5. 5.
    Safran DG. Defining the future of primary care: what can we learn from patients? Ann Intern Med. 2003;138:248–55.PubMedGoogle Scholar
  6. 6.
    Jeffords R, Scheidt M, Thibadoux GM. Physician-patient electronic communications. Med. Group Manage J. 1999;(suppl):46–9.Google Scholar
  7. 7.
    Kleiner KD, Akers R, Burke BL, Werner EJ. Parent and physician attitudes regarding electronic communication in pediatric practices. Pediatrics. 2002;109:740–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Moyer CA, Stern DT, Dobias KS, Cox DT, Katz SJ. 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.
    Katz SJ, Nissan N, Moyer CA. Effect of web-based communicating system on clinic resource use and patient and physician satisfaction in primary care: a randomized controlled trial. Society of General Internal Medicine Annual Meeting. 2003. J Gen Intern Med. 2003;18(suppl 1):207. Abstract.Google Scholar
  10. 10.
    Katz SJ, Moyer CA, Stern DT, Cox DT. Effect of a triage-based e-mail system on clinic resource use and patient and physician satisfaction in primary care: a randomized controlled trial. J Gen Intern Med. 2003;18:736–44.PubMedCrossRefGoogle Scholar
  11. 11.
    Committee on Quality of Health Care in America IoM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: The National Academy of Sciences; 2000. Available at: Accessed June 3, 2003.Google Scholar
  12. 12.
    van der Kam WJ, Meyboom de Jong B, Tromp TF, Moorman PW, van der Lei J. Effects of electronic communication between the GP and the pharmacist, the quality of medication data on admission and after discharge. Fam Pract. 2001;18:605–9.PubMedCrossRefGoogle Scholar
  13. 13.
    van der Kam WJ, Moorman PW, Koppejan-Mulder MJ. Effects of electronic communication in general practice. Int J Med Inf. 2000;60:59–70.CrossRefGoogle Scholar
  14. 14.
    Mandl K, Kohane IS, Brandt AM. Electronic patient-physician communication: problems and promise. Ann Intern Med. 1998;129:495–500.PubMedGoogle Scholar
  15. 15.
    American College of Physicians. The Changing Face of Ambulatory Medicine—Reimbursing Physicians for Computer-based Care: ACP Analysis and Recommendations to Assure Fair Reimbursement for Physician Care Rendered Online. American College of Physicians 2003 Policy Paper. (Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, Pa 19106).Google Scholar
  16. 16.
    Maguire P. How one health plan pays physicians for cybercare. ACP Observer. September 2000. Available at: Accessed June 3, 2003.Google Scholar
  17. 17.
    Wynn P. Paying for cybercare? Health plans study the benefits of reimbursing for e-mail consultations. Health Plan Magazine. 42:42–3.Google Scholar
  18. 18.
    McNamara D. Feee-based e-mail consultation tested in California. Internal Medicine News. 2002;35:32–34.Google Scholar
  19. 19.
    Solovy A. E-mail minus “e-mail.” A California study shows that online communication can benefit patients, physicians and payers. Hospital & Health Networks. 2002;76:26.Google Scholar
  20. 20.
    Relay Health. The RelayHealth Web Visit Study: Final Report. January 2003. Available at: Accessed June 3, 2003.Google Scholar
  21. 21.
    Moyer CA, Stern DT, Katz SJ, Fendrick AM. “We got mail”: electronic communication between physicians and patients. Am J Manag Care. 1999;5:1513–22.PubMedGoogle Scholar
  22. 22.
    American Medical Association. Guidelines for Physician-Patient Electronic Communications. Available at: Accessed April 4, 2003.Google Scholar
  23. 23.
    Cole J. Surveying the Digital Future—Year Three: UCLA Center for Communication Policy. Los Angeles, Calif: The UCLA Internet Report; 2003.Google Scholar
  24. 24.
    Madden M. America’s Online Pursuits, the Changing Picture of Who’s Online and What They Do. Pew Internet and American Life Project; 2003. Available at: Accessed June 11, 2003.Google Scholar
  25. 25.
    Health Insurance Portability and Accountability Act of 1996. Public Law No. 104–191. Section 1173, USC 201.Google Scholar
  26. 26.
    National Research Council. Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure. For the Record: Protecting Electronic Health Information. Washington, DC: National Academy Press; 1997.Google Scholar
  27. 27.
    Horrigan JB. Broadband adoption at home: a Pew internet project data memo. May 18, 2003. Available at: Accessed June 11, 2003.Google Scholar
  28. 28.
    White CB, Moyer CA, Stern DT, Katz SJ. A content analysis of e-mail communication between patients and their providers: patients get the message. J Am Med Inform Assoc. 2004;11:260–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Kane B, Sands DZ. Guidelines for the clinical use of electronic mail with patients. J Am Med Inform Assoc. 5:104–11. Available at: Accessed June 3, 2003.Google Scholar
  30. 30.
    Maguire P. How one group gives a new meaning to “virtual” access. ACP Observer. April 2003. Available at: Accessed April 8, 2003.Google Scholar
  31. 31.
    Hundley K. Doctors offering “concierge” care. St. Petersburg Times Online. July 28, 2001. Available at: Accessed May 7, 2003.Google Scholar
  32. 32.
    Haeg A. Top-shelf health care—if you have the money. Minnesota Public Radio. June 24, 2002. Available at: Accessed May 7, 2003.Google Scholar

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  1. 1.Departments of Medicine and Health Management and PolicyUniversity of MichiganAnn Arbor
  2. 2.Veterans Affairs Ann Arbor Healthcare SystemUniversity of MichiganAnn Arbor
  3. 3.Department of Health Management and PolicySchool of Public Health, University of MichiganAnn Arbor
  4. 4.Global REACH (Research, Education, and Collaboration in Health)University of MichiganAnn Arbor

Personalised recommendations