A re-conceptualization of access for 21st century healthcare.

Journal Article (Journal Article;Review)

Many e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.

Full Text

Duke Authors

Cited Authors

  • Fortney, JC; Burgess, JF; Bosworth, HB; Booth, BM; Kaboli, PJ

Published Date

  • November 2011

Published In

Volume / Issue

  • 26 Suppl 2 /

Start / End Page

  • 639 - 647

PubMed ID

  • 21989616

Pubmed Central ID

  • PMC3191218

Electronic International Standard Serial Number (EISSN)

  • 1525-1497

Digital Object Identifier (DOI)

  • 10.1007/s11606-011-1806-6


  • eng

Conference Location

  • United States