UCSF Study Finds Health Systems Fail To Address Digital Access Gaps

At UCSF in San Francisco, an analysis published Feb. 25, 2026 in JMIR Formative Research warns that hospitals and clinics are rolling out telemedicine and patient portals without routinely checking whether patients can use them. The study, funded by the National Institutes of Health, concluded many health systems fail to identify or address barriers that prevent patients from using digital health tools.

The researchers surveyed nearly 150 clinicians and informatics leaders from health care systems across the country during the first half of 2024, with Elaine C. Khoong, MD, associate professor of medicine at UCSF and faculty member of the UCSF Action Research Center for Health, listed as senior author. Just 44% of respondents said they asked patients if they could use digital devices, according to the UCSF analysis.

The gap was larger at facilities serving uninsured populations: among institutions that serve uninsured patients, only about one‑third asked patients about digital access or skills. Khoong framed the stakes plainly: “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.”

Khoong, who practices as a general internist and works in clinical informatics, detailed concrete examples observed within UCSF Health: patients missed critical messages sent through the hospital’s online app because they didn’t know they had an account, and others were sent text or email links but didn’t understand how to open them. Those anecdotes underscore the study’s argument that simple screening for device access and basic digital literacy is frequently skipped.

The question of access intersects with cost. Tradeoffs reported that UCSF began letting clinicians bill for messages that required some medical decision‑making and took more than a few minutes in November 2021; patients began receiving a notification from the online health portal before sending a message warning it could result in a bill. Tradeoffs summarized the financial exposure this way: “The cost to patients ranged from $0 to $75 out-of-pocket on average, depending on their insurance.”

At the same time UCSF documented access gaps, its Division of Clinical Informatics and Digital Transformation measured automation’s effect on clinical work. A DoC‑IT analysis of nearly 1.2 million ambulatory encounters between January 2023 and April 2025 across 1,565 physicians found 698 physicians (44.6%) adopted AI scribe technology. AI scribe adopters generated 1.81 more relative value units per week — a 5.8% increase — and handled 0.80 more patient encounters per week, a 2.8% increase; the analysis estimated about $3,044 in additional annual revenue per physician using 2025 Medicare payment rates. “These findings provide initial evidence that AI scribes change how physicians code and bill, and may increase productivity and patient access to care,” said A Jay Holmgren, PhD, MHI, lead author of that study.

UCSF is also developing systems to monitor AI risks. Healthcare IT News reported UCSF Health and DoC‑IT are designing the Impact Monitoring Platform for AI in Clinical Care, or IMPACC, to flag tools that are potentially dangerous or risk worsening health disparities and to be tested with a set of AI tools currently used for clinical care. As Mayo Clinic Platform medical director Sonya Makhni warned in earlier remarks quoted by Healthcare IT News, “There are plenty of justifiable worries about what looks to be a new normal built around this powerful and fast‑changing technology.”

The combined picture is stark for San Francisco health leaders: NIH‑funded UCSF research documents a failure to screen for basic digital readiness even as institutions deploy billing policies for portal messaging, adopt AI scribes that change coding and workflow, and build monitoring platforms like IMPACC. Whether local hospitals and community clinics will begin routine screening, patient education, and targeted support to close the access gap will determine if San Francisco patients benefit from digital care or are further left behind.