Instead, she logged on to the Internet and sent him an e-mail from her Salt Lake City home. Since the two had an established relationship, he felt comfortable telling her she needed to increase her dosage.

"It saves time. It saves money. . . . I just feel like it's a better way of doing things for me," said Neumann, who uses an oxygen tank to combat a chronic lung-damaging disease. She e-mails her two University of Utah physicians for laboratory results, prescription refills and at times, medical advice.

At Intermountain Health Care, internal medicine physician Greg Stevens gets two to three e-mails per week from his patients. A retired physician recently e-mailed him with a question about his wife's blood pressure medication. It took Stevens just moments to respond - without involving a receptionist, a nurse or an office visit.

"A lot of my patients just love it," Stevens said.

Though online correspondence between doctors and patients is relatively new in Utah, it's becoming customary elsewhere, where recent research shows it is saving patients, doctors and insurance companies time and money.

Physicians communicating online with patients at the University of California-Davis hospital and clinics were 11 percent more productive than doctors in a study who didn't, said Eric Liederman, medical director of clinical information systems.

Tech-savvy doctors saw an average of 2.5 extra patients per day, which means an extra $20,000 per year for those seeing patients regularly.

There was also an 18 percent reduction in telephone volume a year after the study began, in 2001.

"Your second largest cost is handling the phones . . . it's very disruptive to the practice," said Eric Zimmerman, senior vice president of marketing for RelayHealth. The Emeryville, Calif., company provides UC-Davis with a secure Web site.

The 2001 study found a majority of patients and physicians preferred using Web communication, instead of an office visit, for non-urgent health issues. Patients were also less likely to have missed work due to illness, compared to patients who did not use the Internet service.

Blue Shield of California sponsored the study, completed by researchers at University of California-Berkeley and Stanford University. BlueCross BlueShield of Massachusetts began a pilot of its own in 2003.

"We expect the costs will be equal or lower," said Tanya Trombly, director of provider support. The company hopes to increase access to care, she said.

In Utah, Intermountain Health Care has a secure site called My Personal Info, which has been working since January. About 2,500 patients and 50 physicians use the system to renew prescriptions, adjust appointments, request referrals and look up medical records.

"We are trying to get our physicians used to the idea of online communication," said Belle Rowan, project manager for My Personal Info.

University of Utah Hospitals and Clinics hopes to implement a similar site within the next couple of years.

IHC has not yet sought reimbursement for its doctors who spend time with patients online - seen as a critical factor for encouraging widespread use.

Rowan said the company will launch a pilot next year to determine whether reimbursing doctors would be cost effective.

"The given is that the physician should get some kind of reimbursement for when [the online visit] replaces an office visit," she said.

Douglas Hasbrouck, assistant director of medical services for Regence BlueCross BlueShield of Utah, said the group hasn't begun to reimburse doctors yet because he hasn't detected a market demand.

Hasbrouck said it is also important to make sure the technology would replace existing costs, not create new ones that would drive up insurance premiums.

By 2006, the insurance company plans to have a secure messaging system of its own, which it may offer to patients and their physicians.

Though e-visits may become more common as time goes on, doctors and medical experts emphasize that face-to-face visits will remain vital to effective health care.

"I think [e-mailing] can help facilitate communication, but it won't replace the traditional [visit,]" said Pierre Pincetl, chief information officer of information technology services at the University of Utah Health Sciences Center.

tpeterson@sltrib.com

When to touch base through e-mail

When it makes sense:

* Scheduling an appointment.

* Learning results of laboratory tests.

* Managing medications.

* Caring for a chronic disease or condition.

* Asking questions embarrassing to ask in person.

* Getting instructions for care before and after surgery.

* Follow-up care.

When it doesn't:

* Emergency care

* First-time visits

* Between doctors and patients without established relationships

Sources: Mohit Ghose,

spokesman for America's Health Insurance Plans; Tom Houston, assistant professor of medicine at the University of Alabama Birmingham.