We agree with the correspondents' suggestions and thank them for the very helpful specific examples they provide. We add a few comments herein.
Chistensen and Oldenburg convincingly describe the use of electronic portals for patients to access their test results. As such portals are refined and become more widely available, they are likely to be very useful to both patients and physician practices. Whether they use such portals, physicians should design their systems for managing test results so that they work well for vulnerable patients: those who are elderly, cognitively impaired, relatively uneducated, speak English poorly, and/or have multiple medical conditions. A recent study demonstrated that even within Kaiser Permanente, an integrated health system on the leading edge of health information technology, a “digital divide” exists; racial/ethnic minority patients and those with limited educational attainment were much less likely to use Kaiser Permanente's Web-based personal health record.1
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