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Health Aff (Millwood). 2014 Oct;33(10):1817-22. doi: 10.1377/hlthaff.2013.1145.

Patient-to-physician messaging: volume nearly tripled as more patients joined system, but per capita rate plateaued.

Author information

Bradley H. Crotty ( is director of patient portals in the Division of Clinical Informatics, Beth Israel Deaconess Medical Center, and an instructor in medicine at Harvard Medical School, both in Boston, Massachusetts.
Yonas Tamrat is a primary care internist at Johnson Health Center, in Lynchburg, Virginia.
Arash Mostaghimi is an instructor in dermatology at Brigham and Women's Hospital, in Boston.
Charles Safran is chief of the Division of Clinical Informatics, Beth Israel Deaconess Medical Center, and an associate professor of medicine at Harvard Medical School.
Bruce E. Landon is a professor of health care policy at Harvard Medical School.


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.


Access To Care; Information Technology; Organization and Delivery of Care; Primary Care; Research And Technology

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