New UCSF survey adds to growing concern that some patients — particularly those who are older — could be left without the ability to access health records or make appointments
Health records, accessing appointment information and reordering prescription medications — all are tasks that patients are doing online more and more through the use of digital tools rather than in person or via phone calls.
But such processes could potentially be letting some patients fall through the cracks, according to a new report out of UCSF. In a survey of nearly 150 clinicians in 2024, less than half reported screening patients for their ability to use digital tools. One-third of those who specifically work with uninsured patients reported screening for that information. If patients are unable to use such tools, they could be missing critical health-care information or critical steps in maintaining their health, said Dr. Elaine Khoong, the senior author of the paper, who is an associate professor of medicine at UCSF and a faculty member at the UCSF Action Research Center for Health. “If this is the main way that we’re encouraging people to get care, it’s really inaccessible for a large number of individuals,” Khoong said. “In particular, I think what we see a lot is that older adults have challenges using some of these digital tools, and they’re often the ones who have more chronic illnesses.” Khoong said she initially started thinking about the issue when she realized that her colleagues didn’t necessarily think to ask their patients whether or not they could use such tools. Physicians will screen their patients for “social determinants” of health, or environmental factors that can contribute to health conditions, such as housing or food insecurity.“I increasingly think of being able to access digital tools or having digital inclusion as something like a social determinant of health,” she said. Those who struggle with such systems are often older, non-English speaking people who are lower income or have had less access to education resources, Khoong said. The digital divide has been documented in previous studies, particularly in older adults reluctant to embrace new technology. A 2023 paper at the National Library of Medicine website found that privacy concerns and lack of understanding of medical language were also factors in some patients’ avoidance of such tools. Khoong said that — at least anecdotally — what she often sees happening is that a patient will be sent a message in their patient portal, and when she follows up with them, they say they never received the message, opened the message or even properly set up their portal account.Ex // Top Stories Vesuvio occupies a special place in North Beach The iconic bar keeps its cocktail and drink prices more accessible than the average San Francisco bar SF paramedic puts his heart into saving lives Public education — in every language — is the passion of Nicholas Koo Block’s massive cuts stoke fears about AI’s effects on employment The financial-services company formerly known as Square is cutting 40% of its staff, saying fewer workers can get more done with AI tools She said that many of her older patients have asked her to physically mail them important information — such as test results or appointment reminders — instead, because “that’s what they’re used to, and that’s what works for them.” But despite what some might prefer, digital innovation and the embrace of tools such as artificial intelligence continue to be at the forefront of the health-care industry. A 2024 McKinsey article found that 90% of 200 surveyed health-system executives said that digital and AI were top priorities. Some of the priorities that respondents were most aligned on were patient-facing, such as patient experience and access through virtual health, with 152 respondents saying they’d already implemented investments in that area and 71% ranking it among the investment priorities with the largest potential effect. But with all that investment and adoption of technological innovations, Khoong said, patients themselves and their experiences aren’t being taken into consideration enough. “I just don’t think this is something that we have been thinking about that often,” she said. “I think we just sort of assume a lot of our patients can access care in this way.” If patients were brought in to help design the tools, then perhaps some of the issues could be addressed, according to the conclusion in the 2023 National Library of Medicine paper. Khoong said that a lot of tools right now seem “more clinician-centric, rather than patient-centered.” Sometimes, tools like AI can actually be helpful — they can make it easier for clinicians to understand their patients and what sort of care and interventions might work best for them, and Khoong said there is a lot of opportunity there. But even with the implementation of those tools, there could be roadblocks, she said. Some patients might not have access to the type of technology those tools require, such as older devices or devices with operating systems that don’t support AI. “A lot of my patients have older Android devices,” Khoong said. “That’s what they can afford, and sometimes they can’t use certain apps that we are recommending or that we’re using.” The use of digital tools is only going to continue to grow, but Khoong said she hopes that with the UCSF survey and other research being done on the issue, health-system leaders and clinicians will begin communicating more with patients. “We need to ask patients and screen for it before we make assumptions about whether or not something’s going to work for them,” she said. “That’s sort of the big, big operational takeaway.”
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