Patients are increasingly expected to manage large parts of their care online, whether that means speaking with a doctor through a screen, arranging appointments, renewing prescriptions, or viewing test results via digital portals. While these tools promise convenience and efficiency, they also assume a level of comfort with technology that not all patients possess. For many, what is designed to simplify care can instead become another barrier to accessing it.
However, a new study from the University of California, San Francisco, suggests that health systems are often overlooking a fundamental question: do their patients actually have the means and ability to use these digital services? Without assessing access to devices, internet connectivity, or digital literacy, organisations may be widening existing gaps rather than closing them. The shift towards digital care, while well-intentioned, risks excluding those already at a disadvantage.
The researchers gathered responses from nearly 150 clinicians and informatics leaders working in health systems across the United States during the first half of 2024. Fewer than half—just 44 per cent—reported that they routinely asked patients whether they could use digital devices. The numbers were even lower among institutions serving uninsured populations, where only about one-third carried out such checks. These findings highlight a concerning disconnect between the adoption of digital tools and the realities faced by patients.
Dr Elaine C. Khoong, an associate professor of medicine at UCSF and senior author of the study, emphasised that not everyone benefits equally from digital innovation. Those who struggle to access or use these tools are often the same individuals who already experience poorer health outcomes and limited access to care. The study, published in February in the journal JMIR Formative Research and funded by the National Institutes of Health, brings attention to how digital transformation can unintentionally reinforce health inequalities.
Drawing on her experience as both a general internist and clinical informaticist, Khoong has witnessed patients missing important medical messages simply because they were unaware they had an online account. Others received links by text or email but did not know how to open them. These seemingly small gaps in understanding can lead to missed information, delayed care, and increased frustration, particularly for those who are already navigating complex health issues.
The researchers argue that healthcare organisations should take a more proactive approach by training staff to assess patients’ digital readiness using standardised tools. They also suggest that policymakers should create stronger incentives for such assessments, integrating them into routine screenings alongside factors like housing instability, food insecurity, and domestic abuse. Yet significant barriers remain, with many respondents citing limited time and resources as major challenges. Even among those who do screen for digital access, nearly half reported lacking the support needed to help patients engage with online systems. These challenges have been compounded by recent policy changes, including the termination of the Affordable Connectivity Program in mid-2024, which had provided internet subsidies to low-income households.
More information: Jonathan J Shih et al, Screening by Health Care Systems for Barriers to Patient Engagement With Digital Health Care: Cross-Sectional Survey Study, JMIR Formative Research. DOI: 10.2196/85205
Journal information: JMIR Formative Research Provided by University of California – San Francisco