ppy 

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 this HINTS Brief, we explore factors associated with online patientprovider communication. 

In the past 12 months, have you used 

the Internet or e-mail to communicate 

with a doctor or doctor’s office? 

2003 and 2005 Estimated U.S. Population 

Percentages among Internet Users 

0

5

10

15

20

25

30

35

40

2003 

2005 

Refused 0% 

Don’t Know 0% 

Yes Yes 

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? 

Neither 47% 

E-mail or 

Internet 56.8% 

Refused 0.1% 

Don’t Know 0.6% 

2003 Estimated 

U.S. Population 

Percentage 

Going Online to Communica

Health Care Providers 

Shifting Trends from 2003 to 2005 

A recently published HINTS study revealed changing patterns 

patient-provider communication between 2003 and 2005. 

In 2003, HINTS respondents who had Internet access and w

graduates were almost four times more likely than responde

online and had less than a high school education to have repo

communicating with a health care provider online. In 2005, in

observed no significant differences in online patient-provider 

by education level, suggesting that low levels of education ma

of a barrier to this practice among Americans who are alread

HINTS respondents who were online and living in a non-met

2003 were significantly less likely than respondents who were 

in a metro area to say they communicated online with health 

By 2005, geographic area was no longer associated with onlin

with providers.This may suggest that as Internet access in ru

improved over time, location may be becoming less of a barr

communication with providers. 

HINTS respondents who were online and said that their hea

“fair” or “poor” in 2003 were almost one and a half times m

respondents who reported being in good health to say that t

communicated online with a provider. By 2005, health status 

associated with online patient-provider communication. How

were observed by personal cancer history, with those report

cancer being almost twice as likely as those without a person

cancer to say that they contacted their providers online. 

from HINTS suggest it may be increasing. 

• In 2003, 7% of Internet users said they had commun

with a health care professional in the past 12 month

the percentage of Internet users who reported onli

communication with a health care provider increase

• While health care providers have acknowledged the 

benefits of online communication, issues such as co

reimbursement, and workload must be addressed fo

to become commonplace. 

In this HINTS Brief, we explore factors associated with online patient-provider communi
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 inform

technology (IT) department to ask about policies that 

regarding the transmission of patient information via 

the Internet. 

• Survey your health care providers to assess the exten

online communication with patients, and potential fac

barriers to adopting new communication methods th

unique needs of your organization and patient popula

• Look for alternative ways to connect patients with cr

information, such as through the NCI Cancer Informa

LiveHelp instant messaging service, or through the We

63 NCI-designated cancer centers, based at large rese

universities nationwide. 

About H

http://hints.c

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS) in 2002 and 2003, surv

Americans.The second survey was fielded in 2005, surveying 5,586 Americans. HINTS was created to monitor changes in the rap

field of health communication.The survey data can be used to understand how adults 18 years and older use different communi

channels to obtain health information for themselves and their loved ones, and to create more effective health communication s

across populations. 

HINTS Briefs provide a snapshot of noteworthy, data-driven research findings.They introduce population-level estimates for spec

in the survey and summarize significant research findings that are a result of analyzing how sociodemographic variables influence 

outcomes.The Briefs are intended to highlight top-level findings derived from analyses reported in other venues, and are not me

comprehensive reports. 

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 

References Used in This HINTS Brief 

Beckjord EB, Finney Rutten LJ, Squiers L,Arora NK,Volckmann L, Moser R

Use of the internet to communicate with health care providers in the Un

from the 2003 and 2005 Health Information National Trends Surveys (HI

Res. 2007 Jul 12;9(3):e20.
 

Baker L,Wagner TH, Singer S, Bundorf MK. Use of the Internet and E-ma

Information: Results from a National Survey. JAMA. 2003;289(18):2400-240

Pew Internet & American Life Project. Home Broadband Adoption 2006.
 

URL: http://www.pewinternet.org/pdfs/PIP_Broadband_trends2006.pdf
 

November 2007