“productivity.” Under this new rule, care would be available through many new modes of communication, and would be accessible to patients exactly when they need it, any day at any time, not just between 8:00 a.m. and 5:00 p.m. weekdays. The Internet is likely to be a major platform for such communication.

Face-to-face visits will likely continue to be an important form of clinician and patient interaction; for many people, some direct human contact is critical to establish and maintain a strong healing relationship. Face-to-face visits also allow the clinician to physically examine the patient and observe the patient’s demeanor. But in many cases, face-to-face visits are not wanted by either clinician or patient, nor are they truly needed. Substituting other forms of care, such as electronic communication, for some face-to-face visits presents an opportunity not only to improve care—make it safer, more effective, patient-centered, and timely—but also to make it more efficient.

Through the judicious use of electronic and other forms of communication, it may also be possible to make more clinician time available to improve the quality of the face-to-face visits that do occur. In today’s health care system, necessary face-to-face visits are often delayed or rushed. There may be insufficient time during the visit to understand the psychological underpinnings of symptoms or their relationship to other ongoing health problems. And there may be little time to provide the patient and family with information about a health condition and