the Internet, and an estimated 93 million of these 126 million people were using it to access health information (Madden and Raine, 2003). Nearly one-third of these users reported having broadband connections. One study found that 40 percent of all Internet users had sought advice or information about health or health care, and one-third stated that the information obtained had affected a health care decision (Helms, 2001). In a survey by the Pew Internet and American Life Project, 61 percent of respondents said the Internet had improved the way they took care of themselves either “a lot” or “some.” And while some are concerned about the quality of online health information, the ability to contribute to a more informed patient population is embraced by many health professionals.

Although Internet access is growing, however, some groups lag behind, including racial and ethnic minorities, those with low incomes and educational levels, older people, and residents of rural areas (Madden and Raine, 2003). Progress is being made in closing some of these gaps. Between 1998 and 2001, for example, the growth of Internet use in rural areas increased from 24 to 53 percent (OTP, 2004). A community-based effort to build the necessary telecommunications infrastructure and provide training for computer literacy will help residents to improve information access and communication for multiple purposes, including health care.

The proportions of practicing physicians who work online from home, from their personal office areas, and from their clinical work areas are all increasing (Taylor and Leitman, 2001). A nationwide survey of 834 physicians comparing 1999 and 2001 data found that by 2001, 55 percent of all practicing physicians were using e-mail to communicate with professional colleagues and 34 percent to communicate with their support staff, while 42 percent of all physicians worked in practices with websites. However, only 13 percent of all doctors were communicating with any of their patients via e-mail, and 7 percent of physicians were not online anywhere (Taylor and Leitman, 2001). A survey of the approximately 60,000 members of the American Academy of Family Physicians (25 percent of whom practice in rural areas) found that 80 percent were connected to the Internet, and rapid migration to either digital subscriber line (DSL) or cable modems for high-speed networks was occurring (Kibee, 2004).

Electronic Health Records

Results of an industry survey conducted in 2002 indicate that just 13 percent of private-sector inpatient facilities and 14–28 percent of ambula-



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