How fair is online patient scheduling for mammography?


The findings underscore the continued need to address the problem of health care inequality, wrote a team led by Dr. Patricia Balthazar of Emory University in Atlanta.

“While online portals can allow patients to take charge of their own health records, facilities should recognize that booking appointments online can disenfranchise large numbers of patients, and that several solutions ( as well as awareness and societal improvements in access to technology) will be needed before traditional systems planning methods can be phased out,” the group wrote.

The use of computers and mobile devices can improve patient access to electronic health records and doctors, and help patients schedule appointments, the team noted. But not all patients have internet access.

“Health informatics interventions are likely to inadvertently exacerbate existing health inequalities by disproportionately benefiting already privileged populations and digitally connected individuals,” the group explained.

Balthazar’s team explored whether socio-demographic factors impact patients’ use of an online portal for self-scheduled screening mammography and compared adoption of this option to traditional telephone scheduling. . The study included data from 46,083 women who had a screening mammogram between January and December 2019.

The authors tracked the pathway patients used to schedule the exam, as well as their age, language, race/ethnicity, health insurance status, and postal code (the latter was linked to census data and used to determine internet access, median household income and education level).

The team found that self-scheduling via the online portal was rare: only 0.7% of the study cohort scheduled mammography screening in this way. Those who did were generally younger, English-speaking, white, and had business insurance.

Socio-demographic factors that affected the planning of online mammograms
Variable (p-value) Traditional scheduling Online planning
Age (

60 (average) 53 (average)
English as preferred language (

92.3% 99.7%
Race/ethnicity (0.0043)
Asian 5.8% 3.6%
Black 4.8% 2.3%
Latinx 2.2% 0%
White 8.9% 88.4%
Insurance (

Commercial 63.6% 84.4%
Health Insurance 28.8% 10.9%
Medical help 6.8% 4.3%

So what does the study suggest? Health care disparities exist – and more work needs to be done to address them, say the authors.

“These findings highlight…the contribution of health informatics and digital health interventions to widening the digital divide,” they concluded. “Without strategic implementation, intentionally designed to include all patients, digital health interventions can become an additional barrier to care and lead to intervention-generated inequities.”

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