Who Uses Online Self-Scheduling and Video: Patient Differences in Two 2022 Studies

Online self-scheduling lets a patient choose an appointment slot without phoning staff, and many case studies have described how such tools are implemented ^[3]. For a clinic, therapy practice or care team, the practical question is which patients actually use online booking and which are likely to keep relying on the phone ^[2][3]. Two observational studies published in 2022 address parts of that question, one at University of California San Francisco (UCSF) and one within an integrated delivery system, and a scoping review from the same year places them in context ^[1][2][3].

Definitions and background

The imaging study defines self-scheduling tools as tools that allow patients to schedule visits and imaging studies asynchronously online, meaning at a time of the patient's choosing rather than in a live exchange with staff ^[3]. Synchronous telehealth, by contrast, connects patient and clinician in real time, for example through online, phone or video consultation ^[1].

A scoping review of clinical informatics during COVID-19 searched Medline and Scopus in September 2020 and included 72 of 2716 retrieved articles ^[1]. Telehealth accounted for 36% of included studies and mobile health for 4%, and the mobile applications described were developed as self-triage, self-scheduling and information delivery tools ^[1]. A scoping review maps what was built and studied, so it supports background on the spread of self-scheduling tools rather than conclusions about access ^[1].

Who self-scheduled imaging at UCSF

UCSF deployed a tool, accessed through an electronic health record patient portal, that allowed patients to self-schedule diagnostic imaging studies ^[3]. The investigators analysed electronic health record data for the imaging modalities that could be self-scheduled from January 1 to September 1, 2021 ^[3]. They used descriptive statistics and a multivariable logistic regression model, a method that estimates how each patient characteristic relates to the odds of an outcome while accounting for the other characteristics in the model ^[3]. The abstract does not report the number of patients, odds ratios or confidence intervals ^[3].

Among all active portal users, Latinx, Black/African American and non-English-speaking patients were less likely to self-schedule ^[3]. Patients insured through Medi-Cal, California's Medicaid program, and through Medicare were also less likely to self-schedule than commercially insured patients ^[3]. Because the analysis covered active portal users, these gaps were observed among people who already had access to the portal ^[3].

The authors noted that, of the many case studies describing the implementation of self-scheduling tools, none had explored the impact of self-scheduling on equitable access to care ^[3]. They concluded that efforts to facilitate use of portal-based applications are necessary to increase equity and decrease disparities in access ^[3].

Video or telephone among patients who booked themselves

The second study examined 978 272 patient-scheduled primary care telemedicine visits booked online by integrated delivery system patients between March and October 2020, of which 39% were video visits ^[2]. Using multivariate logistic regression, the investigators found that patients of Black or Hispanic race/ethnicity, and patients living in neighbourhoods with low socioeconomic status or low internet access, were less likely to schedule video visits ^[2]. Patients aged 65 or older, those with prior video visit experience or mobile portal access, and those visiting their own personal provider were more likely to schedule video visits ^[2]. The abstract does not give effect sizes for these associations ^[2].

The authors described video adoption as substantial in all patient groups examined ^[2]. They interpreted the differences as suggesting a persisting digital divide, meaning unequal technology access and use across groups, and emphasised the importance of maintaining a telephone telemedicine option ^[2].

Reading the two studies together

Both studies report the same direction of association for Black patients and for Hispanic or Latinx patients: lower use of the more digital option, whether self-scheduling itself or choosing video once booking online ^[2][3]. Each also reports associations with other factors: insurance type and language in the imaging study, and neighbourhood socioeconomic status and internet access in the telemedicine study ^[2][3].

The findings on age need care. Medicare-insured patients at UCSF were less likely to self-schedule imaging, whereas patients 65 or older who had already booked primary care telemedicine online were more likely to choose video ^[2][3]. These are different outcomes in different populations, and the telemedicine study included only visits already scheduled online, so neither result shows how older adults in general prefer to book ^[2][3].

Neither study establishes that self-scheduling causes disparities; both describe who used a tool, not what would have happened without it ^[2][3].

What this means for a practice offering online booking

The two author groups drew different but compatible implications: the telemedicine authors emphasised maintaining a telephone option ^[2], and the imaging authors called for efforts to facilitate use of portal-based tools so that access is more equitable ^[3]. Neither study evaluated removing phone booking; what they report is that some patient groups were less likely to use the more digital option ^[2][3].

Language and insurance are two specific signals the imaging study measured: non-English-speaking patients were less likely to self-schedule even among active portal users, and Medi-Cal and Medicare patients used self-scheduling less than commercially insured patients ^[3].

SmartMeet combines booking pages and video meetings, sends reminders by email and text, and lets guests reschedule themselves ^[SmartMeet]. The studies discussed here evaluated online scheduling within an integrated delivery system and a university patient portal, not SmartMeet or any comparable product, so they do not indicate how a particular tool would perform ^[2][3].

Limitations

• Both primary studies are observational, and their abstracts report the direction of associations without effect sizes or confidence intervals ^[2][3].
• The imaging study comes from one university health system, UCSF; the telemedicine abstract describes an integrated delivery system but does not name it or state its location ^[2][3].
• The telemedicine data were collected from March to October 2020, during the COVID-19 pandemic, and the imaging data in 2021; neither abstract addresses whether these patterns have persisted ^[2][3].
• The telemedicine study included only visits that patients scheduled online themselves, so patients who booked by phone are not represented ^[2].
• The imaging study analysed active portal users, which leaves out patients without portal access ^[3].
• Neither study tested an intervention to reduce the gaps it identified ^[2][3].
• The scoping review searched two databases in September 2020 and offers background on tool development rather than evidence of effect ^[1].