Using Claims Data to Examine Patients Using Practice-Based Internet Communication: Is There a Clinical Digital Divide?

BACKGROUND: Practice-based Internet communication allows patients to obtain health information, ask questions, and submit requests through a personalized Web site. While such online tools also bring great promise for educating patients with the goal of fostering behavior change, it is important to examine how individuals currently using such services differ from those who do not. OBJECTIVE: The study used administrative information to characterize a population of patients communicating with a medical practice through the Internet during the end of 1999 and through 2000. METHODS: Patient claims data generated during clinical encounters from January 1999 through May 2000 were examined to measure the relationship between patient demographics, frequency of visits, specific acute diagnoses, and specific chronic diagnoses and the use of online communication with the practice. RESULTS: Ten percent of patients, and 13.2% of patients 18 years or older, used the practice Web site. There were differences in use of the practice Web site by age and insurance status, but not by gender. Use of the practice Web site was similar or higher among patients having a diagnosis for a variety of acute and chronic conditions compared to those not having such a diagnosis. Patients with more clinic visits were more likely to use the Web-based service. CONCLUSIONS: Patients using practice-based Internet communication and having significant health risks can be identified through the use of administrative data, presenting an opportunity to test online educational efforts to improve health.