The Internet offers another way for patients to communicate with doctors, one that has been underutilized so far. Patient-physician e-mail correspondence has gained some adherents, but is still not widely used (see Accuracy May Be Casualty in Online Physician Reviews to learn more about new ratings Web sites where patients post reviews of their experiences with doctors).

Physicians worry that e-mail access for patients is impersonal, will be used inappropriately in emergencies, and will take too much time to answer, according to Paul Rosen, M.D., M.P.H., of the Department of Pediatrics at the University of Pittsburgh and Division of Rheumatology at Children's Hospital of Pittsburgh, and C. Kent Kwoh, M.D., of the Department of Internal Medicine at the University of Pittsburgh. Their study appears in the October Pediatrics.

As a test, they offered 328 families an e-mail connection to a pediatric rheumatologist. About 93 percent (306) accepted, and 121 families (40 percent) used the service over two years. A total of 848 patient e-mails, an average of 1.2 a day, were sent to the physician. About 40 percent were initiated after regular office hours. A copy of the e-mail went into the patient's file.

Rosen and Kwoh collected data on 109 of the e-mails and 149 telephone calls during one six-month period. They found that the physician needed between four seconds and 11:54 minutes (mean 2:12 minutes) to answer an e-mail, compared with 36 seconds to 23:12 minutes (mean 5:09 minutes) to complete a phone call—not counting staff time for answering the phone and routing the call. E-mails saved the doctor time, but insurance reimbursement was uncommon. Patients who used the service were generally positive about the experience.

While rare so far—only 30 percent of pediatricians use patient-physician e-mails, the authors noted—the e-mail trial showed that the system did not overburden the physician and could be one method of improving communication and providing consumer-driven health care, said Rosen and Kwoh.

Financial support for the study came from the Arthritis Foundation Eastern Pennsylvania Chapter.

An abstract of "Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery" is posted at:<http://pediatrics.aappublications.org/cgi/content/abstract/120/4/701>.