Health Systems Are Deploying Digital Tools Without Checking If Patients Can Use Them

The digitization of health care has accelerated rapidly. Patients are now expected to book appointments online, communicate with clinicians through portal messaging, view test results on apps, and in many cases conduct primary care visits via video. The assumption embedded in these systems is that patients can use them.

That assumption, according to new research from the University of California San Francisco, is not being tested in most health care settings - and the gap falls hardest on the patients with the fewest resources to compensate.

A survey of nearly 150 clinicians and informatics leaders from health care systems across the United States, conducted in the first half of 2024 and published in JMIR Formative Research, found that only 44% of respondents said their institutions asked patients whether they had the access and skills to use digital health tools. Among institutions that serve uninsured patients - safety-net health systems where patients face the greatest socioeconomic barriers - just one-third asked.

What "Digital Readiness" Means in Practice

Digital readiness is not a single capability. It encompasses whether a patient has reliable internet access (many do not, particularly in rural areas or low-income urban neighborhoods), whether they own a device capable of running health apps or conducting video visits, and whether they have the digital literacy to navigate health portals, understand notifications, and interpret test results presented in online formats.

Elaine C. Khoong, MD, associate professor of medicine at UCSF and senior author of the paper, has seen firsthand how the gap between digital deployment and digital access plays out clinically. "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," she said.

Khoong described specific instances: patients who missed critical messages sent through the hospital's app because they did not know they had an account; others who received text or email links to health information but could not navigate to them. These are not rare edge cases. They are predictable consequences of deploying digital infrastructure without assessing whether the patient population can engage with it.

Screening Without Support

Among the survey respondents whose institutions did ask about digital readiness, nearly half said they lacked the resources to actually help patients who were identified as needing digital support - devices to lend, staff to provide tutorials, or technical assistance programs. Screening for a problem without the capacity to address it can be a hollow exercise that documents a gap without closing it.

Survey respondents identified lack of time and resources as the primary barriers to conducting digital readiness screening. Clinical encounters are already compressed, and adding another screening question to an appointment that may last ten or fifteen minutes competes directly with other clinical priorities.

The researchers propose that digital readiness screening be incorporated into existing social determinants of health assessments - the screening for housing instability, food insecurity, domestic violence, and other social factors that many health systems already conduct. This approach would avoid adding an entirely separate screening process and would situate digital access as a social determinant of health rather than a technical afterthought.

Policy Context and Recent Setbacks

The study notes a deteriorating policy environment. The Affordable Connectivity Program, the federal government's largest initiative to provide subsidized internet access to low-income households, was terminated in June 2024 after Congress declined to renew its funding. The program had helped millions of households afford broadband access; its loss directly worsens the digital divide that health systems have inadequately addressed.

Federal telehealth flexibilities expanded during the COVID-19 pandemic - including reimbursement for audio-only visits for patients without video capability - have also been subject to policy uncertainty, with periodic expiration and extension debates that make it difficult for health systems to plan their digital infrastructure around patients who cannot use video.

The combination of expanding digital health expectations and shrinking public support for digital access represents a widening gap. Patients who already experience worse health outcomes are likely to fall further behind when access to their clinicians increasingly routes through technology they cannot use.

What the Researchers Recommend

The paper calls on health care organizations to train clinical staff to screen for digital readiness using standardized tools, and urges policymakers to create stronger incentives for health systems to conduct this type of assessment. The recommendation to integrate screening into routine social determinants of health processes is practical: it leverages existing infrastructure rather than creating new workflows.

The research was funded by the National Institutes of Health. The study was conducted before the federal program funding cuts described above took effect, meaning the situation it documents may have worsened since the data were collected.