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However, many rural areas remain without high-speed Internet, despite the eagerness of potential customers. This can be attributed to population, location, or sometimes ISPs' lack of interest due to little chance of profitability and high costs to build the required infrastructure. Some dial-up ISPs have responded to the increased competition by lowering their rates and making dial-up an attractive option for those who merely want email access or basic Web browsing.[19][20]

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In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT) and health information technology (HIT) will have on clinician/patient communication moving forward.

The result of the Clalit southern region patient and doctor surveys [1, 2], as well as two other recent surveys in the central region of Clalit, focusing on doctor/patient views on using e-health as a source of patient information [15, 23], suggest that consumers and doctors in Israel (and probably elsewhere) have not quite figured out the rules of engagement for interacting with one another within the e-health milieu. Fully 88% of the patients believe having access to their doctor's personal cell phone number would improve the patient/doctor relationship and 71% of patients say likewise for access to their doctor's personal e-mail [1]. On the physician side at the same clinics, only 2% of doctors are currently willing to give out their direct dial cell phone numbers to all patients and only 3% are prepared to share their direct access e-mail with all patients [2]. However, if the organizational and reimbursement structure were redesigned, (e.g., if providers were paid for this time, or special clinic hours were earmarked for such communication), the great majority of physicians are open to fuller adoption of such new communication tools [2]. 041b061a72


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