To evaluate and compare the attitudes and preferences of younger and older adults regarding health information exchange with providers, and identify barriers and limitations to meaningful use.Cross-sectional study.Qualitative and quantitative data gathered from online surveys of younger and older adult patients enrolled in a freestanding, Internetbased patient-physician messaging system that requires an individual account. This messaging system is only a secure messaging center, and does not allow for direct access to personal medical records.Data were collected from 324 patients (or proxy users) who reported their age, with 55.2% of respondents under the age of 65 years (mean age 48.2 years) and 44.8% of respondents 65 years or older (mean age 74.9 years). Family and non-family caregivers (proxy users) (mean age 59.2 years) comprised 21.0% of respondents. Overall, 83.9% of all respondents preferred to communicate with the provider via e-mail, and 84.5% of users found the messaging system easy to use, with a majority utilizing the messaging system to communicate about health questions and/or medication requests. Finally, 83% of user respondents were satisfied with the messaging system. Results highlight several areas where improvement is needed to increase patient use and satisfaction including adequate patient education, user-friendly interface, and provider engagement. No significant differences between the younger and older adult populations were found.Although a majority of enrolled older adult patients have positive attitudes about health information exchange, electronic communication platforms must address key issues in consumer education, physician commitment, and adoption of an accessible interface to ensure productive older adult consumer participation.