Although online intervention may empower patients and may positively affect the patient-physician relationship, a realistic observation is that the Internet will be widely adopted as a part of usual care only if this venue improves patient self-management, betters patient satisfaction, and enhances health outcomes. To determine the success of Internet-based health care, rigorous outcome studies are needed.

A study by McKay et al found that patients who participated in an online diabetes education and support group lowered their blood glucose levels more than controls did. Studies of online support groups for cystic fibrosis patients, amyotrophic lateral sclerosis (ALS) patients, and single mothers also showed that participants in these online support groups gained satisfaction and confidence in managing their medical condition.

Until recently, the powerful phenomenon of online health care has been largely overlooked by the health care system. As a group, physicians themselves have constituted a major source of resistance to online health care. More than a century ago, a similar backlash in health care accompanied introduction of another technology: the telephone. Soon after invention of the telephone by Alexander Graham Bell, much cultural opposition to it was generated by physicians who doubted that the telephone could add value to medical practice.

As they did with the telephone, however, physicians are becoming less resistant to using the Internet for delivering patient care. Recent estimates of Internet-equipped physicians vary, but these reports agree that physician adoption of the Internet is increasing noticeably, and most agree that physicians (a group sometimes thought technophobic) use the Internet more than do many other sectors of the general adult population. However, physicians have not received information sufficient to convince them that the Internet can help them provide higher-quality care: although 55% of physicians surveyed use e-mail to communicate with professional colleagues, only 13% stated a willingness to send e-mail to patients. In contrast to this finding, 90% of patients surveyed wished to communicate with their physicians by e-mail.