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ABSTRACT Patients want to be able to communicate with their physicians by e-mail. However, physicians are often concerned about the impact that such communications will have on their time, productivity, and reimbursement. Typically, physicians are not reimbursed for time spent communicating with patients electronically. But under federal meaningful-use criteria for information technology, physicians can receive a modest incentive for such communications. Little is known about trends in secure e-mail messaging between physicians and patients. To understand these trends, we analyzed the volume of messages in a large academic health system's patient portal in the period 2001-10. At the end of 2010, 49,778 patients (22.7 percent of all patients seen within the system) had enrolled in the portal, and 36.9 percent of enrolled patients (8.4 percent of all patients) had sent at least one message to a physician. Physicians in the aggregate saw a near tripling of e-mail messages during the study period. However, the number of messages per hundred patients per month stabilized between 2005 and 2010, at an average of 18.9 messages. As physician reimbursement moves toward global payments, physicians' and patients' participation in secure messaging will likely increase, and electronic communication should be considered part of physicians' job descriptions.
Web-based patient portals that offer patients a view of their medical records were first in- troduced in 2000.1 A cardinal feature of most patient por- tals is secure messaging, which allows patients and physicians to communicate electronically in an asynchronous fashion. Secure messaging of- fers patients a convenient way to contact their physicians outside of office visits. Surveys have shown that the vast majority of patients who are Internet users desire the ability to e-mail their physicians.2-5 However, only about 10 percent of these patients are able to do so.6
Despite patients' interest, clinicians have been slow to incorporate secure messaging into their practices.7,8 Recent data suggest that only 9 per- cent of doctorsoffered a patient portal that could allow secure messaging.9
The convenience to patients is clear. However, receiving large numbers of messages can burden busy physicians.8,10-12 Like telephone calls with patients, secure messaging is generally not a re- imbursed activity. Liability concerns may also arise, as physicians may be providing care via e-mail without actually examining the patient.13 However, studies generally...