Key Insights

• Direct scheduling is a component of some electronic health record (EHR) systems that allows patients to schedule appointments with their primary care physicians online at their convenience.
• A cross-sectional study of more than 62,000 patients and 134,000 primary care visits reveals socioeconomic disparities in patients who use direct scheduling.
• The study suggests that direct scheduling is worsening the “digital divide.”

Direct scheduling empowers patients to schedule their own appointments at their convenience on their computer using their physician’s patient portal or through an app on their mobile phones. In addition to being more accessible to patients, direct scheduling reduces administrative burden for physicians and their office staff, decreases no-show rates, and has been shown to improve continuity of care. 

Direct Scheduling Disparities

The JAMA Network conducted a cross-sectional study of EHR “data from 17 adult primary care practices” of “patients 18 years or older” who used direct scheduling. Researchers used the EHR data to “identify patient characteristics associated with direct scheduling adoption,” such as race and ethnicity.

The study found that “across these 17 primary care practices offering direct scheduling,” early adopters of direct scheduling “were more likely to be younger and White and to have commercial insurance.”

This finding shows that direct scheduling excludes a large demographic of patients and that gap may widen as healthcare technology continues to expand. The study suggests that as “direct scheduling is used more widely, this service may widen socioeconomic disparities in primary care access” in terms of continuity of care. In another study, nonusers of direct scheduling were more likely to be “male, be on Medicaid, lack a regular provider, and have less than a college education.”

What This Means for Independent Physicians

The digital divide in healthcare is not a new concept. As healthcare IT becomes more sophisticated, it excludes those who reside in rural or underserved areas, which may lack the infrastructure needed to support high-speed internet access. Barriers to access create a divide that can affect patient outcomes. In addition to electronic limitations, some patients are unwilling to use online services due to lack of health literacy. Nonusers also cited privacy concerns and distrust of healthcare technology as their main reasons for not using direct scheduling or other online tools.

Because the digital divide and direct scheduling can affect patient outcomes, it is important for physicians to review their practice operations. Independent physicians who use online management may want to aggregate their EHR data to see which of their patients utilize direct scheduling the most and reach out to patients who do not to remind them of this service. During encounters, independent physicians can ask their patients how they utilize technology in order to identify any gaps in patient enrollment or marketing. Independent physicians can advertise their direct scheduling and other online capabilities with emails, collateral, waiting room television ads, and flyers.