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Research Letters | Health Care Reform

Yes We Can? Can All Americans Join the Imminent Electronic Health Care Revolution? A Survey of Patients Receiving Care at a Public Hospital FREE

Hau Liu, MD, MBA, MPH; KhenYian Cheung, BA; Dena M. Bravata, MD, MS
Arch Intern Med. 2009;169(16):1535-1536. doi:10.1001/archinternmed.2009.251.
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A critical component of President Obama's health care reform effort has been to expedite the development and widespread adoption of electronic health records. Many health care provider organizations are making electronic health information available to patients.1 While 81% of US adults were reported to be online in 2008,2 the percentage of patients receiving care at public hospitals who use the Internet is uncertain. A decade ago, Robinson and colleagues3 reported that only 20% of disadvantaged patients served by a public hospital had Internet access. Since then, others have shown low Internet use among patients receiving care in public hospital systems, typically ranging from 10% to 20%.4,5 To evaluate whether patients receiving care at a public hospital would benefit from the provision of electronic health information, we sought to characterize the trends in current Internet and mobile telephone use of an ethnically diverse population receiving care at a public hospital in northern California.

We distributed a questionnaire evaluating current Internet and mobile telephone use and willingness to receive electronic health information to adults visiting health care providers in 5 primary care and specialty clinics in a public hospital (August-November 2008). The questionnaire was provided in English, Spanish, and Vietnamese languages; responses were anonymous. We performed logistic regression to evaluate the association of respondent characteristics with their use of electronic media and willingness to receive electronic health information. This project received institutional review board approval.

A total of 283 adults completed the survey, 54% of whom reported using the Internet in the last year (Table). Internet use varied significantly by age (18-39 years, 71%; 40-64 years, 53%; ≥65 years, 36% [P = .003]) and ethnicity (white, 80%; Asian American, 49%; Hispanic, 38% [P < .001]) but not sex. Whites were more willing to receive health information via the Internet (29% vs 17% [P = .03]).

Of the respondents, 45% reported using e-mail and 39% stated that they would be willing to receive health information by e-mail. Not surprisingly, the greatest predictors of willingness to receive health information by email was prior e-mail use (P < .001) and age younger than 40 years (P = .09). Also, 75% of respondents owned mobile telephones and 41% indicated a willingness to receive health information via mobile telephone. The predictors of willingness to receive health information by telephone were telephone ownership (P = .03) and age younger than 40 years (P = .053).

Although a decade has passed since the evaluation by Robinson and colleagues3 revealed low Internet access in patients receiving care at a public hospital, Internet use among this vulnerable population still lags significantly behind the general population. However, our respondents had significantly higher Internet use than has been previously reported,46 and our white respondents' use of the Internet mirrored that reported in the general population. The higher use in our population may reflect more recent trends or the generally higher use of the Internet in Silicon Valley, California, where our hospital is located. Given that only literate patients completed the survey, our results may overestimate the true rate of Internet use in the population.

We found significantly higher Internet use among younger adults and whites. Interestingly, many white respondents received care from a clinic for homeless and injection drug users, suggesting that these differences are not solely related to socioeconomic status. Disappointingly, we found that most respondents, including regular Internet users and owners of mobile telephones, did not wish to receive health information electronically.

Great strides are expected in electronic health information technologies in the coming decade.1,6 Policies and programs are needed to ensure that all Americans have the skills and resources necessary to benefit from these advances. Only then can we affirm that “Yes, we can!” will provide for the health and welfare of all Americans.

Correspondence: Dr Liu, Endocrinology Division, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128 (hauliu@stanford.edu).

Author Contributions: Dr Liu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Liu. Acquisition of data: Liu and Cheung. Analysis and interpretation of data: Liu, Cheung, and Bravata. Drafting of the manuscript: Liu, Cheung, and Bravata. Critical revision of the manuscript for important intellectual content: Liu and Bravata. Statistical analysis: Liu and Bravata. Administrative, technical, and material support: Liu and Cheung. Study supervision: Liu.

Financial Disclosure: None reported.

Tang  PCLee  TH Your doctor's office or the Internet? two paths to personal health records. N Engl J Med 2009;360 (13) 1276- 1278
PubMed
Harris Interactive Inc, Four out of five adults now use the Internet.  Rochester, NY Harris Interactive2008;http://www.harrisinteractive.com/harris_poll/index.asp?PID=973. Accessed June 27, 2009
Robinson  CFlowers  CWAlperson  BLNorris  KC Internet access and use among disadvantaged inner-city patients. JAMA 1999;281 (11) 988- 989
PubMed
Helft  PREckles  REJohnson-Calley  CSDaugherty  CK Use of the internet to obtain cancer information among cancer patients at an urban county hospital. J Clin Oncol 2005;23 (22) 4954- 4962
PubMed
Wu  EShah  NR Low Internet use among patients with diabetes in a safety-net population. AMIA Annu Symp Proc October11 2007;1158
Wagner  THBaker  LCBundorf  MKSinger  S Use of the Internet for health information by the chronically ill. Prev Chronic Dis 2004;1 (4) A13
PubMed

Figures

Tables

References

Tang  PCLee  TH Your doctor's office or the Internet? two paths to personal health records. N Engl J Med 2009;360 (13) 1276- 1278
PubMed
Harris Interactive Inc, Four out of five adults now use the Internet.  Rochester, NY Harris Interactive2008;http://www.harrisinteractive.com/harris_poll/index.asp?PID=973. Accessed June 27, 2009
Robinson  CFlowers  CWAlperson  BLNorris  KC Internet access and use among disadvantaged inner-city patients. JAMA 1999;281 (11) 988- 989
PubMed
Helft  PREckles  REJohnson-Calley  CSDaugherty  CK Use of the internet to obtain cancer information among cancer patients at an urban county hospital. J Clin Oncol 2005;23 (22) 4954- 4962
PubMed
Wu  EShah  NR Low Internet use among patients with diabetes in a safety-net population. AMIA Annu Symp Proc October11 2007;1158
Wagner  THBaker  LCBundorf  MKSinger  S Use of the Internet for health information by the chronically ill. Prev Chronic Dis 2004;1 (4) A13
PubMed

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