Patient use of secure electronic messaging within a shared medical record: a cross-sectional study

J Gen Intern Med. 2009 Mar;24(3):349-55. doi: 10.1007/s11606-008-0899-z. Epub 2009 Jan 10.


Background: Most patients would like to be able to exchange electronic messages with personal physicians. Few patients and providers are exchanging electronic communications.

Objective: To evaluate patient characteristics associated with the use of secure electronic messaging between patients and health care providers.

Design, setting, and patients: Cross-sectional cohort study of enrollees over 18 years of age who were enrolled in an integrated delivery system in 2005.

Measurements and main results: Among eligible enrollees, 14% (25,075) exchanged one or more secure messages with a primary or specialty care provider between January 1, 2004 and March 31, 2005. Higher secure messaging use by enrollees was associated with female gender (OR, 1.15; 95% CI, 1.10-1.19), greater overall morbidity (OR, 5.64; 95% CI, 5.07-6.28, comparing high or very high to very low overall morbidity), and the primary care provider's use of secure messaging with other patients (OR, 1.94; 95% CI, 1.67-2.26, comparing 20-50% vs. <or=10% encounters through secure messaging). Less secure messaging use was associated with enrollee age over 65 years (OR, 0.65; CI, 0.59-0.71) and Medicaid insurance vs. commercial insurance (OR, 0.81; 95% CI, 0.68-0.96).

Conclusions: In this integrated group practice, use of patient-provider secure messaging varied according to individual patient clinical and sociodemographic characteristics. Future studies should clarify variation in the use of electronic patient-provider messaging and its impact on the quality and cost of care received.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Chronic Disease
  • Cross-Sectional Studies
  • Delivery of Health Care, Integrated
  • Electronic Mail / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Medical Records Systems, Computerized*
  • Middle Aged
  • Odds Ratio
  • Physician-Patient Relations*
  • Retrospective Studies
  • Sex Factors
  • Young Adult