Doctors and patients using an electronic health and medical record: research studies offer multiple views of 21st century health care.

“I already know you better (after several e-mails) than the internist I was seeing since 1990,” wrote a new patient of Chuck Kilo, MD, MPH, at Portland’s Greenfield Health, who believes that the relationship between doctors and patients is built on continuous communication, requiring multiple modes and encounters. With the developing electronic capability that doctors and patients now have, to complement their traditional forms of interaction—the office visit, the hospital visit, the telephone—they can form quicker and deeper relationships than previously possible; and both can access data in a common electronic medical record. All of the Original Articles in this issue represent a research and applications view of various components of this developing integrated electronic capability. Patients can now contact their physician by secure e-mail online—a new physician-patient e-communication—which resulted in Kaiser Permanente patients sending more than one million electronic messages to their physicians in 2006. E-communication will develop along the same continuum as have personal visits: from simple e-data to e-mail exchange to e-encounter to ecorrespondence to e-conversation. The question becomes: How easily can doctors translate their patientsatisfying, personal office visit behaviors into a satisfying e-visit? Can doctors write a subjective, personal piece of e-correspondence? (MyChart—A New Mode of Care Delivery: 2005 Personal Health Link Research Report, page 14; see Figure 1 #1.) With the electronic medical record available in the exam room, “it” could disrupt the personal visit. The effect that “it” has on patients depends on the doctor, though its intrusion can be positive, and, through involvement and by improved understanding, can enhance communication and relationship between patient and doctor. (Implementing the Electronic Medical Record in the Exam Room: The Effect on Physician-Patient CommuniDoctors and Patients Using an Electronic Health and Medical Record: Research Studies Offer Multiple Views of 21st Century Health Care