This study investigated utilization of computer-based telemedicine in three
rural Missouri counties. Participating health care agencies were given com
puters and access to an Internet-based workstation that provided e-mail and
World Wide Web (WWW) services. Ten rural practices from three Missouri cou
nties were profiled. Utilization data for email messages sent and received,
along with the number of WWW pages accessed, were collected through a prox
y server. Results showed that most physicians received more messages than t
hey sent and utilized the WWW more than they did e-mail. Moreover, physicia
ns connected to a tertiary care center and who currently use extenders in t
heir practice are more likely to use Internet technology, even if it is thr
ough a proxy user such as a nurse practitioner or office staff.