Patients are now expected to navigate much of their care online - from seeing their doctor on a screen to booking appointments, refilling prescriptions, and checking test results through health care portals.
Yet, according to a new study by UC San Francisco, most health systems are skipping a crucial step: asking whether their patients have the access and skills to use these digital tools.
The researchers surveyed nearly 150 clinicians and informatics leaders from health care systems across the country during the first half of 2024. Just 44% said they asked their patients if they could use digital devices. Among the institutions that serve uninsured patients, just one-third asked.
"Not everyone can access all these new digital health tools we're rolling out, and the people who are excluded are often those who experience worse health outcomes and limited access to care," said Elaine C. Khoong , MD, associate professor of medicine at UCSF and a faculty member with the UCSF Action Research Center for Health .
Khoong is the senior author of the paper, which appeared Feb. 25 in the journal JMIR Formative Research . The research was funded by the National Institutes of Health (NIH).
As a general internist and clinical informaticist, Khoong has seen patients miss critical messages sent through the hospital's online app because they didn't know they had an account. Others were sent text or email links but didn't understand how to open them.
She and her co-authors say health care organizations should train their health workers to screen for digital readiness using standardized tools, and policy makers should create stronger incentives for health systems to do this type of assessment. They recommended that it should be incorporated into other routine screenings for things like housing instability, food insecurity, and domestic abuse.
Those who responded to the survey said the lack of time and resources were their biggest barriers to screening. And among those who did screen, nearly half said they did not have the resources to help their patients access or learn to use the organization's online tools.
Since the survey, Congress made cuts to federal digital access programs. In June of 2024, the Affordable Connectivity Program, which is the nation's largest internet subsidy for low-income households, shut down after Congress failed to renew its funding.
Authors: Jonathan J. Shih and Andersen Yang, MPH, of UCSF, are co-first authors of the study. Other UCSF co-authors include Vivian E. Kwok, MPH, Emilia H. De Marchis, MD, Marika Dy, MPH, Carmen Ma, Nilpa D. Shah, MPH, Kelsey H. Natsuhara, MD, Urmimala Sarkar, MD, MPH, and Anjana E. Sharma, MD. For all authors, see the paper.
Funding: This study was supported by the NIH's National Center for Advancing Translational Sciences (UCSF-CTSI UL1 TR001872), National Institute on Aging (P30AG015272), National Heart Lung and Blood Institute (K23HL1577500), and National Institute of Minority Health and Health Disparities (K23MD016439). Additional funders include the UCSF Population Health and Health Equity Funding and the California Health Care Foundation.
Conflicts: None declared.
