Early experiences with e-health services (1999-2002): promise, reality, and implications

Med Care. 2006 May;44(5):491-6. doi: 10.1097/01.mlr.0000207917.28988.dd.


Background: E-health services may improve the quality and efficiency of care; however, there is little quantitative data on e-health use.

Objective: The objective of this study was to examine trends in e-health use and user characteristics.

Research design: This was a longitudinal study of e-health use (1999-2002) within an integrated delivery system (IDS). We classified 4 e-health services into transactional (drug refills and appointment scheduling) and care-related (medical and medication advice) services.

Subjects: Approximately 3.3 million members of a large, prepaid IDS.

Measurements: Amount and frequency of e-health use over time and characteristics of users.

Results: The number of members registered for access to e-health increased from 20,617 (0.7% of all members) in Q1 1999 to 270,987 (8.6%) in Q3 2002. Between Q1 and Q3 2002, 42,845 members (1.3%) used the drug refill service and 55,901 (1.7%) used the appointment scheduling service compared with 10,756 members (0.3%) who used the medical advice service and 3069 (0.1%) who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses/user versus 1.6 uses/user among care-related service users. Members most likely to use e-health services had a high level of clinical need, a regular primary care provider, were 30 to 64 years old, female, white, and lived in a nonlow socioeconomic status neighborhood. These findings were consistent across e-health service types.

Conclusions: Although use of all e-health services grew rapidly, use of care-related services lagged significantly behind use of transactional services. Subjects with greater clinical need and better ties to the health system were more likely to use both types of e-health services.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Appointments and Schedules
  • California
  • Child
  • Child, Preschool
  • Continental Population Groups / statistics & numerical data
  • Delivery of Health Care, Integrated / methods
  • Delivery of Health Care, Integrated / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Information Services / statistics & numerical data
  • Longitudinal Studies
  • Middle Aged
  • Multivariate Analysis
  • Pharmaceutical Services / statistics & numerical data
  • Sex Distribution
  • Socioeconomic Factors
  • Telemedicine / statistics & numerical data*
  • Telemedicine / trends*