Mar 2001

The Digital Divide

Audiey Kao, MD, PhD
Virtual Mentor. 2001;3(3):101-102. doi: 10.1001/virtualmentor.2001.3.3.dykn1-0103.


  • An ad in California seeking riders for the Pony Express read: "Wanted. Young, skinny, wiry fellows. Not over 18. Must be expert riders. Willing to risk death daily. Orphans preferred." From April 3, 1860 to late October 1861, the Pony Express provided the fastest mail delivery between St. Joseph, Missouri and Sacramento, California on a trail length of nearly 2,000 miles. More than 180 men were known to have ridden for the Pony Express, and the fastest of these men once delivered the mail in 7 days and 17 hours. The Pony Express was officially ended on October 24, 1861 after the completion of the telegraph.
  • More than two billion e-mails are sent and delivered nearly instantaneously each day in the United States. In a survey of over 15,000 physicians, 69 percent of respondents use e-mail for personal communication, but only 3 percent send e-mail to patients1.
  • The majority of adults ages 18 to 59 (55 percent) who have Internet access on a home computer use this technology to get health or medical information; as compared to getting information on entertainment, sports, and hobbies (78 percent) or making investments in stocks and bonds (19 percent)2.
  • Adjusted for computing power and speed, computer prices have fallen several fold in the last 5 years, but a digital divide still exists among individuals based on race, education, and income. White Americans have greater access to the Internet or e-mail at home than African Americans (57 versus 38 percent). Those with some college education are more likely than others (65 versus 41 percent) to have Internet/e-mail access. Individuals earning $50,000 or more have greater access to the Internet (72 percent) than individuals earning between $30,000 and $50,000 (50 percent have access) and individuals earning less than thirty thousand dollars (31 percent access)2.
  • The medical use of e-mail is projected to increase, given patient demand and potential cost savings for medical practices, but many legal, ethical, and economic issues remain surrounding its appropriate uses3, 4, 5, 6. For example, many argue that documented informed consent should be a prerequisite for e-mail communication between physicians and patients, but no standards for obtaining that consent currently exist. Protecting the privacy of e-mail communications between patients and physicians is another serious consideration, as is the question of whether physicians who use e-mail to communicate with their patients should be reimbursed for that form of consultation.


  1. Baldwin G. Bringing docs online takes tact. Internet Health Care. 2000; Jan-Feb:32-41.

  2. Brodie M, Flournoy RE, Altman DE, Blendon RJ, Benson JM, Rosenbaum MD. Health information, the Internet, and the digital divide. Health Aff (Millwood). 2000;19(6):255-265.
  3. DeVille K, Fitzpatrick J. Ready or not, here it comes: the legal, ethical, and clinical implications of e-mail communications. Semin Pediatr Surg. 2000;9(1):24-34.
  4. Spielberg AR. On call and online: sociohistorical, legal, and ethical implications of e-mail for the patient-physician relationship. JAMA. 1998;280(15):1353-1359.
  5. Baur C. Limiting factors on the transformative powers of e-mail in patient-physician relationships: a critical analysis. Health Commun. 2000;12(3):239-259.
  6. Bergenson B. E-mail: a realistic conduit for patient-doctor communications? J Med Pract Manage. 2000;15(4):208-210.


Virtual Mentor. 2001;3(3):101-102.



The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.