The American Health Information Community (AHIC), a recently formed federal commission, identified secure online communication between physicians and patients—especially those with chronic conditions—as one of a limited number of “breakthrough” information technologies targeted for rapid development.1 Moreover, public opinion polls show that 80 percent of online Americans would like to communicate with their doctors via e-mail. Nevertheless, physician adoption of patient e-mail is growing slowly and remains low. Only about one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-05, up from one in five physicians in 2000-01, according to HSC’s nationally representative Community Tracking Study (CTS) Physician Survey . . . The 20 percent growth in physician-patient e-mail between 2000-01 and 2004-05 lagged growth in access to IT for other clinical activities, such as writing prescriptions and accessing patient notes.