Brief 8: On-line Communication with Health Care Providers: eHealth behaviors and trends
In this HINTS Brief, we explore factors associated with online patientprovider communication.
Online Patient-Provider Communication: Rare Despite Popularity of Internet and E-mail
An emerging concept known as "eHealth" seeks to capitalize on the promise of new media technologies to facilitate equal access to timely and credible health information. One such eHealth endeavor is online patientprovider communication. For more than a decade, studies have consistently shown that the public would like to have access to Internet-based communication with health care professionals.
Data from the Health Information National Trends Survey (HINTS) indicates that most Americans say that health care providers are a more trusted source of health information than the Internet; however, HINTS data also shows us that the Internet is the most frequently used source for health information retrieval. In fact, when asked where they went for health information in their last search, most respondents to HINTS said they used the Internet, print media, and other resources more often than health care providers. Online patient-provider communication is one way to utilize the public’s most preferred and most often used sources of health information.
The Pew Internet & American Life Project estimates that 73% of Americans are online, and that 93% of them use e-mail. Despite apparently high levels of Internet access, online patient-provider communication is rare. In 2003, it was established that 7% of Internet users responding to HINTS said they had communicated online with a health care professional during the past 12 months. In 2005, this percentage increased to 10%.
While many health care providers have acknowledged the potential benefits of online patient-provider communication, concerns persist about confidentiality, reimbursement, and workload. In general, preference for online communication is higher among patients than among providers.
In the past 12 months, have you used the Internet or e-mail to communicate with a doctor or doctor’s office?
People get information about cancer, including how to prevent it and find it early, from many sources.
Assuming it was free, would you like to get this information by e-mail or the Internet?
Quick Facts
- An estimated 73% of American adults are online, and 93% of them use e-mail.
- Online patient-provider communication is uncommon, though data from HINTS suggest it may be increasing.
- In 2003, 7% of Internet users said they had communicated online with a health care professional in the past 12 months. In 2005, the percentage of Internet users who reported online communication with a health care provider increased to 10%.
- While health care providers have acknowledged the potential benefits of online communication, issues such as confidentiality, reimbursement, and workload must be addressed for the practice to become commonplace.
Going Online to Communicate with Health Care Providers
Shifting Trends from 2003 to 2005
A recently published HINTS study revealed changing patterns in online patient-provider communication between 2003 and 2005.
In 2003, HINTS respondents who had Internet access and who were college graduates were almost four times more likely than respondents who were online and had less than a high school education to have reported communicating with a health care provider online. In 2005, investigators observed no significant differences in online patient-provider communication by education level, suggesting that low levels of education may be posing less of a barrier to this practice among Americans who are already online.
HINTS respondents who were online and living in a non-metro/rural area in 2003 were significantly less likely than respondents who were online and living in a metro area to say they communicated online with health care providers. By 2005, geographic area was no longer associated with online communication with providers.This may suggest that as Internet access in rural areas has improved over time, location may be becoming less of a barrier to online communication with providers.
HINTS respondents who were online and said that their health status was "fair" or "poor" in 2003 were almost one and a half times more likely than respondents who reported being in good health to say that they had communicated online with a provider. By 2005, health status was not associated with online patient-provider communication. However, differences were observed by personal cancer history, with those reporting a history of cancer being almost twice as likely as those without a personal history of cancer to say that they contacted their providers online.
Online Communication with Providers: Differences by Gender and Cancer History
In 2005, no evidence of a "digital divide" among Internet users who communicate with providers online
Contrary to previous studies that have documented differences in online communication with health care providers by age, race/ethnicity, and income, a recently published analysis using HINTS suggests that in 2005, only gender and a personal history of cancer predicted differential use of the Internet for communicating with providers among those HINTS respondents who were already online.Though college education and metro area residence were associated with being more likely to communicate online with providers in 2003, these factors were no longer associated with the practice in 2005.
In a recent HINTS 2005 publication, gender and personal cancer history were independently associated with online patient-provider communication after adjusting for other factors (e.g., age, education, income, race, health insurance, geographic area).
Gender
Among Internet users in 2005, women were almost one and a half times more likely than men to have communicated with a health care provider online.
Cancer History
Among Internet users in 2005, those who said they had a personal history of cancer were almost twice as likely to report communicating online with a health care provider than those respondents without a personal history of cancer.
How Can This Inform Your Work?
The HINTS survey does not reveal health care providers’ opinions about online communication with patients, nor does it inform us of policies regarding e-mail communication with patients and the potential confidentiality and reimbursement issues that this emerging practice might evoke. However, the HINTS data do reveal frequent use of the Internet for health information and a strong preference for seeking health information from health care providers.
There are several steps that health educators and health communication practitioners can take to customize efforts to enhance patient-provider communication locally.
- Check in with colleagues in your organization’s information technology (IT) department to ask about policies that may exist regarding the transmission of patient information via e-mail or the Internet.
- Survey your health care providers to assess the extent of their online communication with patients, and potential facilitators and barriers to adopting new communication methods that meet the unique needs of your organization and patient population.
- Look for alternative ways to connect patients with credible online information, such as through the NCI Cancer Information Service’s LiveHelp instant messaging service, or through the Web sites of the 63 NCI-designated cancer centers, based at large research universities nationwide.
References Used in This HINTS Brief
Beckjord EB, Finney Rutten LJ, Squiers L, Arora NK, Volckmann L, Moser RP, Hesse BW. Use of the internet to communicate with health care providers in the United States: estimates from the 2003 and 2005 Health Information National Trends Surveys (HINTS). J Med Internet Res. 2007 Jul 12;9(3):e20.
Baker L, Wagner TH, Singer S, Bundorf MK. Use of the Internet and E-mail for Health Care Information: Results from a National Survey. JAMA. 2003;289(18):2400-2406.
Pew Internet & American Life Project. Home Broadband Adoption 2006. URL: http://www.pewinternet.org/~/media//Files/Reports/2006/PIP_Broadband_trends2006.pdf.pdf
For More Information on Cancer
- Call the NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)
- Visit http://cancer.gov
- Order NCI publications at http://www.cancer.gov/publications
November 2007
