Interest in virtual visits for simple medical problems was higher among patients who had previously used the Internet to order products online (74.6% vs 45.0%, P < .001). Patients with chronic diseases were more likely to be interested in virtual visits for simple medical problems (70.8% vs 62.2%, P = .213), although this association was not statistically significant. A higher education level was associated with obtaining medical information over the Internet. College graduates were more likely than nongraduates to have used the Internet to obtain medical information (50% vs 33.6%, P < .05).
TABLE 1
Internet use among computer-using patients
| Type of use | % |
|---|---|
| Internet used at least once | 93.8 |
| E-mail used as a means of communication | 90.0 |
| Hours of Internet use each week | |
| 0–4 | 38.4 |
| 5–8 | 25.8 |
| 9–12 | 18.2 |
| 13–16 | 3.0 |
| >16 | 14.6 |
| Have used the Internet to order online | 69.2 |
| Have used the Internet to pay bills online | 19.1 |
| Have used the Internet to obtain medical information | 58.4 |
TABLE 2
Internet services desired by computer-using patients
| Service | Mean Likert score* |
|---|---|
| Receive e-mail reminders about appointments | 8.61 |
| Receive updates about advances in treatment | 8.56 |
| Make an appointment online with immediate confirmation | 8.50 |
| Obtain prescription refills | 8.47 |
| Send a message to your doctor | 8.40 |
| Look at your medical records through a secure site | 8.32 |
| Obtain a referral | 8.26 |
| Receive e-mail reminders about upcoming health services | 8.22 |
| Receive e-mail reminders about upcoming clinic services | 8.14 |
| View immunization records | 8.04 |
| Complete registration/reason for visit online | 8.00 |
| Send updates on health/condition to your doctor | 7.97 |
| Communicate with provider regularly about chronic disease | 7.90 |
| Send requests for medical record release | 7.88 |
| Send feedback/suggestions to clinic | 7.83 |
| Obtain recommendations on good patient education sites | 7.48 |
| Request an appointment by e-mail, receive response within 24 h | 7.46 |
| Send a message to billing | 7.45 |
| Obtain specific directions and map to clinic | 6.75 |
| Use a computer in the clinic waiting room for medical information | 6.74 |
| Obtain links to health insurance company Web sites | 6.73 |
| Take a virtual tour of the clinic or hospital | 6.26 |
| *Likert scale: from 1 (least important) to 10 (most important). | |
Discussion
Patients who used computers and the Internet showed significant interest in using Web-based services from their family physicians. These patients were especially interested in using the Internet for front desk services and common tasks, which are frequently provided over a busy telephone line. Services related to providing information were of less interest, and patients displayed only moderate interest in virtual visits. Using PC videoconferencing instead of e-mail communication would increase patients’ interest in a virtual visit. Poor videoconferencing capability over PCs, lack of access, or perhaps a fear of insufficient security over Web-based communications might limit interest.6-8
The survey had several limitations. As noted, only 7.4% of noncomputer users took the survey when requested by front desk staff. Therefore, we limited our analysis to computer-using patients. However, given the current statistics of Internet use and growth in access to all sectors of our population, it is likely that most practices will find a sufficient percentage of “connected” patients to apply the study’s findings. Assessment of online use at a specific clinic site will be useful in prioritizing the need and application of Internet services. The low response rate of our survey is likely due to the voluntary nature of the survey and the challenge of the front desk staff in finding time to encourage patients to take the survey. The practices that participated were busy ones that must move patients in a timely fashion from the front desk area to examination rooms.
Businesses with many employees who use e-commerce and banking services may especially benefit from signing up with a practice that offers online services. Patients with chronic diseases usually require more frequent visits with their physicians. We hope that patients with chronic disease will take advantage of “virtual visits” as they become available, thereby freeing them from transportation costs, lost time, and productivity.
Other desired services such as online appointment scheduling, medication refills, and referral requests might improve the efficiency in front and back office functions by reducing the number of lengthy telephone calls. We hope to perform future studies that evaluate the impact of Internet services on efficiency and patient/provider satisfaction.
Physicians should place a high priority on building service components into their practice Web sites. Interfacing these Web-based services with electronic medical records is another important task that needs further programmer development and attention by physicians. We hope that continued research in e-health care will further catalyze technologic developments that improve disease management, increase practice efficiency and patient satisfaction, and reduce medical errors.
Acknowledgments
The authors thank Lu Sandoval and Coline Bublitz for their help in preparing the data. They also thank Richard Drexilius, MD, at the Swedish Family Medicine Center; Manoj Pawar, MD, at the Exempla Family Medicine Center; and Carl Severin, MD, at the Kaiser Centerpointe Clinic for allowing the authors to perform the survey at their facilities. Special thanks to Perry Dickinson, MD, for his editorial assistance.