Proceedings

• • • Slide Presentation Handouts

Paper

Session 75
Evaluating the Impact of Patient Internet
Access to Medical Records
AUTHORS/PRESENTERS

Stephen J. Clark, PhD

Vice President of Information Services and
CIO
University of Colorado Hospital
Denver, Colorado

Chen-Tan Lin, MD
Medical Director of Informatics
University of Colorado Hospital
Denver, Colorado

2002 ANNUAL HIMSS CONFERENCE & EXHIBITION

COPYRIGHT © 2002 BY THE HEALTHCARE INFORMATION AND MANAGEMENT SYSTEMS SOCIETY. 1

INTRODUCTION
Giving patients access to their medical records has been proposed as a method for improving medical
care by better educating patients and more fully engaging them in medical decision-making. Such
access holds promise for educating patients about their medical conditions; improving adherence to
medical and lifestyle changes; increasing trust in the physician; better preparing the patient for the
office visit; enhancing the patient’s sense of mastery over his or her condition; providing reassurance
about prognosis; and allowing patients to correct errors in the medical record.
There are, however, potential drawbacks to letting patients view their medical records, including
increased patient worry; increased demands on physicians’ time; interference in the doctor-patient
relationship; lost confidentiality of “third party” reports; and offense taken by patients regarding the
inclusion of sensitive social, sexual, and psychiatric information.
Various attempts to show patients their medical records, in paper or electronic form, have proven
problematic. Paper records are cumbersome and difficult to distribute. Electronic records have been
available for viewing at limited locations and times. As a result, few patients have seen their medical
records, and no controlled study of such access has been done. Thus, it is still not clear to what extent
patients will derive benefit from having easy access to the full medical record, or whether they will
find it confusing and intimidating.

The Internet—A New Access Tool

Today, the Internet presents a convenient and widely accessible vehicle for allowing patients to view
their medical records. It has the potential to be an important tool for improving patient-physician
communication and for making care more patient-centered. Indeed, the Internet is already having a
profound effect on the way that patients and clinicians interact. Patients are accessing medical infor-
mation from a variety of Internet sources (some less reliable than others), enabling them to have
greater input into decision making about their health care. This in turn is causing a dramatic shift in
the traditional physician patient relationship; many patients are no longer relying exclusively on the
physician for information about their health or medical condition.
With growing patient interest in accessing medical information, it is increasingly important that the
medical community understand both the benefits and drawbacks of web-enabled medical care.
University of Colorado Hospital (UCH), chose to devise a cohesive Internet strategy that includes a
personalized patient portal, a personalized physician and employee portal, and plans to bring more of
our information exchanges online. At the time UCH began to design its e-health initiative in 1998, no
one vendor had a cohesive product, so we decided to create a framework to move clinical care online,
one piece at a time. As an integrated care delivery network with a shared, functional Electronic
Medical Record (EMR), we are in a unique position to make this move happen. As an academic med-
ical center, we sought to study the process of this move as it occurred.
We have conducted preliminary studies on e-mail based patient satisfaction surveys, as well as a
study of the influence of patient-physician email communication on the patient-physician relation-
ship. Now we are taking additional steps to augment the existing EMR so that patients can view their
own medical records, and UCH can study the effect of this intervention.
In early 2001, University of Colorado Hospital was awarded a national grant for the first controlled
study of the effect of patient access to unedited electronic medical records via the Internet. This grant,
from The Commonwealth Fund, will enable UCH to expand a pilot Internet access project initiated in
September 2000. This preliminary project provided Internet access to medical records with 11
patients at a small internal medicine practice with two doctors and a nurse practitioner. The
Commonwealth Fund grant will further this research by studying the benefits and drawbacks of
allowing patients from a UCH subspecialty clinic for congestive heart failure to access their unedited
medical records via the Internet.
This paper reports on project work accomplished to date. At the 2002 HIMSS conference, presenters
will report on research undertaken to examine medical e-mail communication at UCH, including cur-
rent usage, attitudes, and barriers to clinician-patient e-mail as perceived by clinicians and patients.
Presenters will also report on initial qualitative data from physicians and patients regarding the poten-
tial for benefit and harm from patient Internet access to medical records. Six months of quantitative e-
mail, workflow and survey data on patient outcomes such as satisfaction, self-efficacy, disease
comprehension and resource utilization will be reported.

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 2

BACKGROUND
The University of Colorado Hospital was founded in 1921 by the Colorado General Assembly as part
of the University of Colorado medical campus. Seventy years later, it became University of Colorado
Hospital Authority governed by a nine-member board of directors. The Authority owns and operates
a 373-bed general acute care hospital, seven outpatient clinics and University Home Therapies, Inc.
UCH is the region’s leading tertiary care and referral center. It is the primary teaching hospital of the
University of Colorado Health Sciences Center campus and is comprised of the Schools of Medicine,
Nursing, Dentistry, Pharmacy and the Graduate School, the Colorado Psychiatric Hospital and other
affiliated centers.
UCH is capitalizing on an opportunity to reinvent its healthcare delivery system as part of a campus-
wide relocation of the University of Colorado Health Sciences Center to the former Fitzsimons Army
Medical Center. The opportunity to create a new academic health sciences center on the Fitzsimons
Campus is made possible by the agreed upon transfer of approximately 217 acres of the Fitzsimons
Army Medical Center to the University of Colorado.
At the Fitzsimons Campus, UCH has taken a major step forward in the concept of providing ambula-
tory care by creating an ambulatory complex, the Anschutz Centers for Advanced Medicine, that is
distinct and separate physically and functionally from the inpatient hospital. All aspects of these new
Centers are based on a vision of putting patients first and involved in their own care. The master plan
for the Anschutz Centers focuses on the “satisfied patient” experience including easy access and
parking, all services needed to support the care provided, and bringing together all specialties so that
the patient has true “one stop shopping.”
This vision has become the roadmap for an advanced IT infrastructure that includes an enterprise-net-
worked Electronic Medical Record, wireless systems, and other technology tools. It has also been the
impetus for an organization-wide e-health initiative that will ultimately employ the Internet to more
directly involve patients in their own care, through online access to a variety of registration, schedul-
ing, insurance, and patient care information.

PROJECT PURPOSE AND OBJECTIVES

UCH’s e-health strategy began as a comprehensive vision that encompassed the development of
smaller individual projects. These projects include 1) email as a means to improve the process of care
(patient satisfaction survey) with a secondary goal of defining a population of internet-savvy patients,
2) Clinician-patient email communication analysis, 3) Providing patients electronic access to their
unedited medical records.

Email Communication
Electronic mail (e-mail) is an increasingly used communications technology. However, relatively few
clinicians have used e-mail to communicate with patients. In November of 2000, a survey by Medem,
a San Francisco-based e-health company, showed that 10 percent of physicians were e-mailing
patients 1. On the other hand, patients have tremendous interest in e-mail: in August 2000, a survey by
VHA, a nationwide network of community-owned health care organizations, indicated that 35 per-
cent of patients would consider switching to an e-mail accessible clinician 2.
There are several concerns about potential usage of e-mail to communicate medical issues. Many
physicians are concerned that patient e-mail will be an additional workload and liability burden for an
already busy practice. In addition, there is growing concern about the “digital divide” separating
those who have Internet access from those who do not. Mandl showed that e-mail and Internet use
grew from 52 percent to 72 percent from 1998 to 2000 among families of a pediatric practice, but that
Internet access was proportional to income.3

UCH CEO E-mail Pilot Project

A pilot project initiated in February 2001 has made e-mail communication with the organization’s
CEO available to patients at a UCH heart clinic through a special kiosk in the clinic lobby. Each time
a patient signs on to communicate with the CEO by e-mail, they are asked three questions:
• Did we (UCH) see you on time?
• Did we answer your questions?
• Did we treat you well?

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 3

Upon receiving a message, the CEO responds by e-mail to the e-mail address given by the patient. As
of August 2001, 374 patients are participating in the e-mail project, communicating issues, concerns,
and experiences with the UCH CEO. Preliminary patient satisfaction studies of the responses indicate
that the majority of patients are satisfied with their experience at UCH. A more formal study of the
satisfaction data will be completed in the next three months. Of special note is evidence that one-third
of the 374 patients who first used the lobby kiosk to e-mail their opinions have now become regular
e-mail correspondents with the CEO.
Installing the e-mail kiosk in the clinic lobby required a small investment of time and money, but has
already yielded a significant payback. Patient satisfaction data is instantly available to the CEO, who
in turn forwards the information to the appropriate area for immediate action. This has eliminated the
need to hire outside consultants to conduct satisfaction surveys with patients at this particular clinic—
a process that often takes up to six months before satisfaction data is researched, communicated and
acted upon.
UCH’s strategy is that the e-mail project will be the mechanism, not only for immediate feedback, but
also for rolling out news of the availability of patient Internet access to medical records to the full
organization, and used to recruit participation in other e-health initiatives.

UCH Survey of Email Usage and Attitudes/Barriers to Patient-Clinician E-mail

Given this rapid growth and increasing debate surrounding clinical e-mail usage, UCH developed
physician and patient surveys to examine medical e-mail communication. Our objectives were to
describe current usage, and to identify and compare attitudes and barriers to clinician-patient e-mail
as perceived by clinicians and patients.
All 1100 faculty clinicians practicing at the University of Colorado Hospital were sent a mailed sur-
vey in the fall of 1999. Several weeks later a repeat mailing was sent to non-responding clinicians.
Additionally, 1000 randomly selected patients enrolled in a managed health care plan administered
by the University were mailed an analogous survey. Information on those who did not respond was
not obtained. Patients were informed that all responses were confidential.

Study Instruments
Two self-administered questionnaires were developed (one for patients and one for clinicians),
reviewed by a professional survey consultant, pilot tested by 20-30 patients and 5-10 physicians, and
further modified for clarity.
Patients were asked whether they had access to e-mail, whether they currently communicated with
one or more of their doctors by e-mail, and if so, how often. They were also asked whether they were
interested in communicating with their doctor by e-mail in the future. Then they were asked questions
about several potential benefits of e-mail communication with their doctor, with response choices
including “yes”, “no” and “not sure.” The potential benefits assessed were: speed, convenience, effi-
ciency, provides printed documentation, eliminates “telephone tag,” saves me money, easier to reach
my doctor, or other comments. They were also asked to respond to questions about the potential risks
of e-mail communication with their doctor on the same rating scale: lack of confidentiality, imper-
sonal, hard to use, lack of access to a computer, lack of timely response, don’t know who is on the
other end, cannot discuss complicated issues, potential for misunderstanding, worry about “bother-
ing” doctor, or other comments.
Physicians were asked the same questions about potential risks and benefits of e-mail, and were also
asked whether they had communicated with colleagues about patients by e-mail, and whether they
were aware of federal patient privacy legislation such as the Health Insurance Portability and
Accountability Act (HIPAA). They also provided demographic information about their sex, year of
medical school graduation, primary or specialty care focus, and what percent of time was spent in
direct patient care.

Results
We received 546 responses (49.6 percent) to two physician mailings, and 409 responses (40.9 per-
cent) to a patient mailing. 97 percent of surveyed physicians have access to e-mail, while 89 percent
of surveyed patients have access. 35 percent of physicians currently communicate with patients via e-
mail, while only 18 percent of patients e-mail their physician. In contrast, 44 percent of all physicians
would be interested in e-mailing patients in the future, while 91 percent of all patients desired e-mail
access to their doctor in the future.
Additional findings include:
• Patients were more likely to view e-mail in a positive light.
• Both physicians and patients felt e-mail eliminated “phone tag,” was faster, more convenient,
more efficient, and allowed printable documentation.

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 4

 • More patients than clinicians felt that e-mail saved the patient money.
• Patients were less likely to cite risks of e-mail communication, such as lack of confidentiality or
possibility of misunderstanding.
In conclusion, about one-third of UCH physicians and one-fifth of UCH patients currently use e-mail
to communicate with each other. 44 percent of physicians and 91 percent of patients would like to do
so in the future. Patients have significantly more positive views and fewer concerns about clinical e-
mail usage than physicians.

The Commonwealth Fund Research Study

UCH has commenced a study funded through a grant from The Commonwealth Fund, to assess the
impact of providing patients electronic access to their unedited medical records. The study, called
SPPARO (System to Provide Patient Access to Records Online) is analyzing both the subjective and
objective effects of such access on the patients, on the physicians, and on their relationships.
Patients and physicians have been recruited from a subspecialty clinic for congestive heart failure at the
University of Colorado Hospital. Work is underway to give patients in the study access to their electronic
medical records via a secure Internet portal. A qualitative study of both patients’ and physicians’ attitudes
about patient access to their electronic medical records will be administered before patients view their
medical records and after six months of patient access. A cohort study of patients with and without access
to their EMRs will quantify the impact of patient access to their electronic medical records.

Setting
This study is being conducted in a subspecialty clinic for congestive heart failure (CHF) at University
of Colorado Hospital. This is a referral clinic that offers consultations and enrollment in clinical trials
for patients with moderate to severe congestive heart failure. Clinicians include six attending physi-
cians and a nurse practitioner. Support staff includes dedicated nurses, medical assistants, and admin-
istrators. Approximately 250-300 patients are seen per month.
This setting was chosen because it provides a patient population with a relatively homogeneous diag-
nosis, making it easier to study the effects of the intervention. Also, because the pathophysiology of
congestive heart failure is complex, with optimal treatment requiring both lifestyle modifications and
the use of multiple medications, interventions that enhance patient self-efficacy and doctor-patient
communication have the potential for great benefit.

Participants
All six attending physicians in the CHF clinic are being interviewed as part of the qualitative study.
Physicians are blinded to which patients are given access to the EMR to prevent any special treat-
ment, conscious or unconscious, for patients with access to the EMR. We are in the process of
enrolling 100 study and 100 control patients from the clinic’s patient population.

Study Design—Qualitative Studies

Qualitative studies will consist of face-to-face semi-structured interviews with a qualified facilitator.
Broad trigger questions will be used to initiate discussion, with generative (not leading) questions to
follow. With the assistance of specialized content analysis software (Atlas.ti), transcriptions of the
interviews will be probed for themes that are brought up repeatedly.
Before study patients are given access to their medical records, the physicians in the CHF practice
will be interviewed individually regarding their expectations—both positive and negative—of provid-
ing patients electronic access to their medical records. Of particular interest will be their expectations
regarding improvements in patient self-efficacy, correcting errors, and doctor-patient communication.
Also of interest will be their concerns regarding the potential for patient confusion, and inefficiencies
from excessive patient inquires, and strain on the doctor-patient relationship. The physicians will be
surveyed individually at nine months into the intervention to assess whether their positive and nega-
tive expectations were borne out.
Patients will receive similar interviews. A subset of the control group of patients will be surveyed
before the intervention regarding their self-efficacy in managing CHF, the quality of their doctor-
patient communications, and their interest in having access to the medical record. The themes devel-
oped in this survey will also help us to enrich the questionnaires that will be used in the cohort study
(as described below).
Nine months into the intervention, a subset of the study group of patients (8-10 total) will be inter-
viewed regarding the pre-intervention questions above. They will also be asked about their experi-
ence with the Web-based medical record, including soliciting their recommendations for
improvements. The study group is not part of the initial qualitative study because the semi-structured
interviews might alter their responses to the intervention.

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 5

Study Design—Cohort study
Study and control patients will receive a variety of surveys before the intervention of the patient-
accessible EMR and at the completion of six months of the intervention.
The centerpiece of the surveys will be the Kansas City Cardiomyopathy Questionnaire (4). This sur-
vey was designed to quantify the impact of new treatments on patient symptoms and quality of life. It
measures important subjective outcomes and reliably reflects objective measurements of health sta-
tus. The primary outcome of the study will be a significant difference in the self-efficacy scales of the
questionnaire.
UCH also will include additional questions on adherence, patient satisfaction, self-efficacy, and the
doctor-patient relationship, on current usage of the Internet, and on patients’ experience reading the
medical record. We have used previously validated questions as available. New questions may be
developed based on the themes that are developed in the pre-intervention qualitative survey of
patients as mentioned above. Surveys will be pilot tested on 20 patients to ensure that the questions
are clear and unambiguous.
The questionnaires will be presented to both groups before intervention, after 6 months, and at the
completion of the study after 12 months. For each patient enrolled (both study and control groups),
we will track number of office visits, as well as emergency department visits and admissions to
University of Colorado hospital. Mortality data will also be compiled.

The Patient Accessible Electronic Medical Record

UCH is in a unique position to study how patient care is affected by Internet access to medical records
because of its EMR system. The current Electronic Medical Record (EMR) system at UCH is a com-
mercial system offered by 3M Health Information Systems called Care Innovation. It is an enterprise-
wide networked system that integrates numerous data sources, including laboratory reports, radiology
reports, and clinician dictation. These data are accessible by clinicians through a Web browser-based
interface. This system has been in use by the majority of 1,000 clinicians at UCH since 1995. Both
primary care and specialty care clinicians have notes transcribed into the system, and both retrieve
data from the shared system regularly.
UCH is modifying this system to allow secure patient access to ONLY their own on-line medical
record. It will also restrict patients to see only certain sections of the record, to include demographic
information, lab reports, radiology reports and clinic progress notes by their cardiologist. Additional
modifications will allow UCH to track patients’ access to their records and which parts of their record
they accessed. Other modifications will provide links to further information about certain laboratory
results and medications.
Also, UCH is developing a new module that will allow patients to send an e-mail to the clinic with
questions or concerns regarding their medical record or their clinical care. This e-mail will be saved
for later content analysis. We will be particularly interested in whether these questions reflect correc-
tion of errors, and whether they result in changes in management.
The privacy of patients participating in the study will be closely guarded. UCH operates in a secure
environment with appropriate and established safeguards. The medical records will be accessible
only by the patients, the treating physicians, and staff. An audit trail of access to patient records will
be maintained and available upon request. Patients will be automatically locked into seeing only their
own medical records. Patients will use a secure messaging system, but will be notified of pending
messages by a generic message to their regular email.
Because the system uses a standard Internet browser interface, it should be intuitive enough so
patients will need little training to use the system. They will be given a sheet of information about the
system and access to a help desk phone line. Because patients cannot be expected to understand lab-
oratory test values, the system will have hypertext links to information on the most common tests
ordered in the CHF clinic so the meaning of the values can be explained.
We plan to defer any training on medical terminology. We are interested in assessing the patient’s
experience reading the medical record as it exists. A study conducted by B. Fisher and N. Britten,
“Patient Access to Records: Expectations of Hospital Doctors and Experiences of Cancer Patients”
(Br J General Pract 1993; 43:52-56), indicates that although a number of patients are unable to under-
stand certain medical terms, these misunderstandings have not created major difficulties. Patients
were still able to glean important information from their medical records.
Patients in the control group will not receive access to the EMR. They will, however, participate in the
questionnaires and initial qualitative survey as described below.

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 6

Captured Data on Patient Use of EMR and E-mail Communication
Data will be captured on when patients access the EMR. This will be compared to the date of their
clinic visit. For each patient, a log will be kept of which parts of the EMR are accessed and when.
Data about e-mail communication will also be obtained. For each patient, a log will be kept of when
e-mail is sent to the clinic from the EMR. (We will encourage study patients who choose to contact
the clinic electronically do so through the EMR rather than through their own e-mail service.) We will
track how many e-mails are sent and their relation to the past and upcoming visits. The content of e-
mail will also be evaluated and categorized. Content analysis will be performed in a manner similar
to that described for the transcriptions of the semi-structured interviews in the qualitative survey.

EXPECTED PRODUCTS OF THE RESEARCH STUDIES

Physicians
From the qualitative studies of physicians, we will describe how physicians perceive the process of
providing patients access to their medical records, including
• The initial hopes and concerns of physicians
• Changes in physician attitudes after implementation
• Impact on workload
• Impact on physician-patient relationship
• Whether knowing patients had access to the medical record affected their style of documentation
• Whether patients seemed more well-informed about their condition as a result of access to their
medical records

Patients
From the pre-intervention qualitative study of control patients, we will describe how patients perceive
the process of providing access to their medical records, including
• Current use of the Internet and e-mail in general
• Current use of the Internet for obtaining medical information
• Concerns about use of the Internet and e-mail for sensitive topics such as financial and medical
information
• Suggestions for elements to include in a valuable patient-accessible EMR
• Perceived need for medical and/or technical advice
From the post-implementation qualitative survey of study patients, we will describe how patients per-
ceived the impact of having access to their medical records, including
• Benefits of reading the medical record
• Negative consequences of reading the medical record
• Ability to understand dictated notes
• System ease of use (e.g. navigating the site, communicating with the clinic)
• Suggestions for further improvement

Cohort study—questionnaires
From the questionnaires used in the Commonwealth cohort study, we will describe the impact of pro-
viding patients access to the EMR on
• Patient self-efficacy
• Functional status
• Adherence
• Knowledge about CHF
• Doctor-patient communication
• Overall patient satisfaction

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 7

Cohort study—use of services
By tracking use of number of office visits, ED visits, and admissions to University of Colorado
Hospital in the control and study groups, we will describe the impact of providing patients access to
the EMR on use of services.

Analysis of Use of EMR and E-mail Communications

By analyzing use of the EMR, we will describe:
• How frequently patients access particular sections of the medical record
• When those sections are read in relation to clinic visits (including nurse visits and phlebotomies)
By analyzing e-mail communications, we will describe:
• Content of messages
• Questions regarding medications, laboratory studies, or dictated notes
• Correction of errors in the record
• New symptoms or concerns, and urgency of those messages
• Mean/median number of e-mails generated per patient
• Length of e-mail messages
• Turnaround time in responding to messages
By analyzing the questionnaire provided to study patients, we will describe patient perceptions of:
• What sort of errors are found in the medical record
• Ease of understanding content of the medical record (medical terminology, laboratory studies)
• Security concerns

STUDY OUTCOMES
The grant-funded research study commenced in July 2001. At the 2002 HIMSS conference, presen-
ters will report on initial qualitative data from physicians and patients regarding the potential for ben-
efit and harm from patient Internet access to medical records. Six months of quantitative e-mail,
workflow and survey data on patient outcomes such as satisfaction, self-efficacy, disease comprehen-
sion and resource utilization will also be reported. The study will supply valuable information on the
effect of patient access to the electronic medical record on the patient’s sense of well being, the
patient’s self-efficacy, and the physician-patient relationship. It will provide both qualitative and
quantitative measures of the impact of such a program.
The Commonwealth study, as well as the e-mail studies, will also provide information on how the
medical system is affected by allowing patients to view the electronic medical record and to commu-
nicate with the clinic by e-mail. Research will provide information on whether the clinical practice
will find such a system to be a valuable adjunct to clinical care or an additional burden.
UCH’s research will also form the basis for future studies. The effects of patient access to medical
records can be evaluated in other patient populations, such as patients with diabetes, or more hetero-
geneous patient populations such as those in primary care. A quantitative study of the impact of such
a system on physicians could also be performed. The patients of study physicians would be provided
access to the EMR while the patients of control physicians would not. This would allow more direct
impact of the effect of such a system on documentation style and effectiveness of doctor-patient com-
munication. The computer system provided could be enriched to provide more doctor-patient interac-
tion, such as electronic patient documentation of home blood sugars or peak flows. It could also be
enriched to provide expanded hyperlinks to personalized medical information.
By describing UCH’s experience with this system, we will provide guidance to hospitals on how to
implement similar systems. Specifically, we will help to determine what parts of the system are most
valuable to patients, and what pitfalls to avoid, especially as regards ease of use, comprehension
and privacy.

CONCLUSION
The Internet has the potential to be a convenient and widely accessible vehicle for allowing patients
to view their medical records, and an important tool for improving patient-physician communication
and for making care more patient-centered. For this reason, it is increasingly important that the med-
ical community understand the implications of this new world of web-enabled medical care.

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 8

The studies in clinician-patient e-mail, e-mail based satisfaction surveys, and ultimately patient
access to their own medical records will help us understand both the benefits and drawbacks of mov-
ing medical care online. The UCH studies will lay a foundation, and point to further research to build
on our limited knowledge of this important issue in medical care.
(For updated results of UCH’s SPPARO study, please visit www.uchsc.edu/uh/gim/himss)

AUTHOR BIOGRAPHIES
Stephen J. Clark, Ph.D., Vice President and Chief Information Officer, University of Colorado
Hospital. In his 30-year career, Stephen Clark has directed the IS departments of ten healthcare
organizations comprising 19 hospitals with staffs of over 100 professionals. At UCH, he is responsi-
ble for overall strategic development and management of information resources and technology.
Chen-Tan Lin, M.D., Medical Director of Informatics, University of Colorado Hospital. C.T. Lin, a
practicing internist, provides leadership and direction on the development of UCH programs to
encourage physician’s use of information technology that supports patient care, research and educa-
tion.

REFERENCES
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Hsih C. Latest research reveals that half of physicians interested in using e-mail with patients if
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Pound B, Evans C, Thomas C. LaurusHealth.com Poll Shows e-Mail Option May Determine
Choice of Doctor. [VHA Survey website]. Available at:
http://www.vha.com/vhassi/news/releases/2000/08_14_00.shtml.
3
Mandl K, Feit S, Pena B, Kohane I. Growth and determinants of access in patient e-mail and
internet use. Arch Pediatr Adolesc Med 2000. 154(5):508-11.
4
Green, P.; Porter, C.; Breshahan, D; Spertus, J. “Development and Evaluation o fhte Kansas City
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American College of Cardiology 2000; 35(5):1245-1255

2002 HIMSS Proceedings: Educational Sessions Session 75 / Page 9