Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2011 Nov;26 Suppl 2(Suppl 2):639-47.
doi: 10.1007/s11606-011-1806-6.

A re-conceptualization of access for 21st century healthcare

John C Fortney  1 , James F Burgess Jr, Hayden B Bosworth, Brenda M Booth, Peter J Kaboli
Affiliations
Review

A re-conceptualization of access for 21st century healthcare

John C Fortney et al. J Gen Intern Med. 2011 Nov.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

None disclosed.

Figures

Figure 1
Figure 1
Conceptualization of access.
See this image and copyright information in PMC

References

    1. Kvedar JC, Herzlinger R, Holt M, Sanders JH. Connected health as a lever for healthcare reform: Dialogue with featured speakers from the 5th Annual Connected Health Symposium. Telemed J e Health. 2009;15:312–319. doi: 10.1089/tmj.2009.9972. - DOI - PubMed
    1. Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemed J e Health. 2009;15(6):600–610. doi: 10.1089/tmj.2009.9960. - DOI - PubMed
    1. Rosenthal TC. The medical home: Growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21(5):427–440. doi: 10.3122/jabfm.2008.05.070287. - DOI - PubMed
    1. Berwick DM. What "patient-centered" should mean: Confessions of an extremist. Health Aff. 2009;28(4):w555–565. doi: 10.1377/hlthaff.28.4.w555. - DOI - PubMed
    1. Penchansky R, Thomas JW. The concept of access: Definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127–140. doi: 10.1097/00005650-198102000-00001. - DOI - PubMed

Publication types