Promote health IT literacy

What is health IT literacy? How is it different from health literacy?

Health information technology (health IT) literacy is a person's ability to effectively find, understand, and use health technology across health and healthcare settings. It is related to but distinct from health literacy, which is a person's ability to find, understand, use, and communicate health information to make informed decisions about their health and healthcare. ^{7 8}

Health literacy varies with a person's role in the healthcare system, such as the clinician or patient. The older adult patient with multiple chronic conditions will have more complex health literacy needs than the young adult patient who is in good health. The adult parent will have different health literacy needs than the pediatric patient. Health literacy even varies among healthcare professionals, such as between clinicians, electronic health record (EHR) developers, and front desk staff. It also varies with use cases, such as cancer care, digital quality measures, and patient-generated health data.

For the patient, caregiver, or family member, health literacy includes understanding basic concepts of health and health conditions, understanding and following written instructions such as medication labels and discharge instructions, and using the healthcare system. Clinicians and staff, in turn, must take each individual's health literacy into consideration when communicating with patients and caregivers, which often include family caregivers.

Similarly, health IT literacy for patients today includes understanding patient portals, how to use them, and how different patient portals organize and display health information of interest. Health IT literacy also involves understanding the evolving contribution of patient-generated health data through portals and devices and the ability to work with and synthesize digital health information across multiple portals to understand one's health status and longitudinal shared care plan.

Like health literacy, health IT literacy varies with a person's role in the healthcare system and the particular use case. For the clinician, it includes finding, understanding, and using EHRs, medical devices, electronic clinical decision supports (e.g., cancer screenings, vaccine schedules, and medication management), and telemedicine tools. For the patient, it includes finding, understanding, and using patient portals, health apps, wearables and devices, and telemedicine tools.

How does health IT literacy affect your practice?

Health IT literacy may affect different practices in different ways depending on characteristics like patient population, geographic setting, or specialty. A rural practice may lack broadband access, making some health IT inapplicable (such as telemedicine) and making experience with alternative kinds of health IT (such as telephone visits or emails with photo attachments in lieu of telemedicine) a strength. A practice serving patients whose first language is not English will need to provide both health information and health technology in the languages its patients use so they can understand and use the information and technology. A diabetes practice might need health IT literacy to help its patients successfully use continuous glucose monitors and insulin pumps, while a pediatrician might depend more on the parent's or parent proxy's health IT literacy than the child's health IT literacy.

While health IT literacy is distinct from health literacy, health IT literacy and the use of health IT affect and can promote health literacy as well. For example, patient portals that show long-term health data help people understand how their health has changed over time. Clinical decision support tools integrated within EHRs help clinicians have a deeper understanding of relevant diagnoses and interventions. Your practice should be thinking about health IT literacy from both the clinician's and the patient's and caregiver's perspectives.

Consider how health IT literacy impacts your practice and patients from the very beginning of any health IT initiative — starting with design and moving through procurement, implementation, testing, training, daily workflows, ongoing monitoring, and evaluation. Considering health IT literacy from the beginning will be more efficient and cost-effective than attempting to retrofit solutions after problems have been uncovered in practice, with accompanying risks to quality and patient safety.

This chapter explores the importance and benefits of health IT literacy, as well as best practices and resources to help clinicians and patients use health information and communication technologies to improve care. It illustrates how health IT literacy in everyday practice can lead to better, more efficient solutions and streamlined workflows, while poor health IT literacy can increase burdens, inefficiency, and costs.

As many as half of U.S. adults have limited literacy skills, and even more — up to 9 in 10 — have limited health literacy skills. ⁹ Think of limited health IT literacy in the same way. Designing for limited-literacy users has a powerful effect: It broadens access to health information and health IT for all users.

Understanding the many facets of health IT literacy can help you integrate it effectively for both staff and patients. You don't need to achieve high health IT literacy across all of these components from the outset, but awareness can help you plan for how best to achieve health IT literacy in each phase. Keep in mind the following areas to understand, promote, and fully leverage health IT literacy.

User groups or roles

Health IT literacy varies depending on a person's role in the healthcare system. A clinician is expected to be proficient with the EHR, while patients and family caregivers may not be as familiar. Conversely, patients may be more comfortable and literate using patient portals than some clinicians. To support patient engagement and access, at least 1 person on the healthcare team with a patient-facing role should be familiar with the patient portal (i.e., super users). These super users could be the clinicians but could also be other members of the healthcare team. They should know how to use it, be able to answer patient questions during visits, and understand the portal's limitations or tradeoffs from the patient's perspective.

Within a single practice, health IT literacy can also differ by role. A clinician may be less skilled than a front desk staffer in using the appointment system, while neither is likely to match an EHR developer or informaticist in detecting bias in scheduling algorithms. ¹⁰

Content

Health IT literacy also varies with the type of content and how it is displayed in health IT systems. For example, you may see a smooth, interoperable referral exchange, while an EHR developer or informaticist sees the underlying semantic codes (such as LOINC or SNOMED CT) and the FHIR® standards enabling that exchange. Similarly, while clinicians may want access to the full range of relevant clinical content, some patient portals present patients with a summary designed to match their literacy level and information needs. However, there is still progress to be made to ensure that all portals account for all literacy levels.

Use cases

A use case describes the steps someone takes to use a system to achieve a specific goal. In health IT, examples of use cases include using a patient portal to schedule a follow-up appointment, complete a family health history questionnaire, or upload personal health indicators like blood pressure. Health IT literacy varies with the health IT and skills needed to achieve the goal of the use case. For instance, the health IT skills required for cancer care are not the same as those needed to calculate and report digital quality measures. And both differ from the health IT literacy skills that patients and their clinicians need to collect, understand, and submit patient-generated health data. While there may be some overlap, the specific demands vary.

Technology

Health IT literacy can also depend on the specific technology. For example, a clinician may be proficient with EHRs but unfamiliar with certain medical devices or health apps. Likewise, a patient may use a wearable device daily yet have little to no literacy with EHR systems. The required skills shift with the technology in use.

Health IT literacy is multifaceted. Your patients and staff do not have to be literate across every aspect of health IT. Rather, different members of your team will and should have health IT literacy in their respective and overlapping spheres. Where the patient or caregiver interacts with the clinical setting, the health IT literacy of the patient, clinicians, and staff should be considered to facilitate effective patient engagement.

Health IT literacy can support your practice and enhance patient and caregiver health literacy by:

• Improving understanding and effective use of health IT
• Building knowledge of health information and its limitations
• Building knowledge of health IT and its limitations
• Strengthening real-time engagement with patients through tools such as online scheduling, secure messaging, reminders, educational resources, medication refill requests, forms, and telehealth
• Enabling patients and family caregivers to support care at home, in the community, while traveling, and in other settings — improving outcomes and reducing practice workload
• Enhancing the clarity, usability, and impact of health information to support health literacy

Each of these benefits can contribute to improving health outcomes and relieving practice load. On the other hand, poor health IT literacy increases practice burden, inefficiency, and costs. When clinicians, staff, or patients cannot effectively find, understand, and use relevant health IT, mistakes can be made, data can be mis-entered or omitted, and health outcomes can be affected. The resulting friction and potential misunderstandings can affect patients' ability to use health IT to increase involvement in their care.

Health IT literacy can affect patient engagement positively or negatively across the different components of health IT literacy listed above. To increase patient engagement, consider how health IT literacy shapes every stage of a patient's or caregiver's experience — from accessing technology to understanding and acting on the information it provides.

Users and roles

Knowing that patients and caregivers have differing levels of health IT literacy for various reasons, consider how patients and caregivers access and use health IT and design for those differing levels. Tailor instructions, education, and training to the different needs of particular patient populations.

Use cases

Similarly, clinicians, specialists, and patients and their caregivers will have differing levels of health IT literacy. Use cases range from a healthy child's routine checkup to an adult managing multiple chronic conditions. Think about how patients and caregivers need to use health IT differently depending on the situation and provide appropriate support and training accordingly to ensure health IT literacy.

Content

Patients and caregivers can gain a better understanding of their health through the content and information available to them, so it's important to provide clear, user-friendly content that they can easily access and understand. Different types of health IT — such as portals, educational materials, and telehealth platforms — and the content within them may each require specific health IT literacy skills. Consider the content your patients use and ensure it matches their abilities and preferences. This will help them use technology and information confidently and effectively.

Technology

Patients and caregivers need tailored, user-centered interfaces that they can access, use, and understand. Specific types of health IT — like devices, wearables, remote monitoring, and telehealth visits — might each require a user to have health IT literacy skills that are specific to the technology. Consider the types of health IT patients are using and what health IT literacy they need to be successfully engaged.

Availability and access

Not all health IT is equally available, and not everyone can fully use what is available. These gaps — often called “digital divides” — show up in many ways. For example, the Federal Communications Commission tracks broadband capacity, which is needed to access services like telehealth, and finds major differences across U.S. counties, especially in rural and Tribal areas. ¹¹ As of 2020, only about 41.5% of people in the United States had broadband internet. ¹² And even when relevant health IT is available, it may not be provided in the languages patients need or may be incompatible with assistive technologies, creating barriers alongside issues like utility insecurity. When planning for patient engagement, consider whether the health IT is truly available and accessible to patients and caregivers.

Usability

Even when health IT, such as patient portals, mobile apps, and remote monitoring devices, is available and accessible, it may still be difficult for patients to understand and use. An analysis of the 2022 Health Information National Trends Survey data found that 53% of participants reported it was “not very easy” to understand the health information in their online medical record or patient portal. ¹³ Barriers can stem from many factors, such as design choices made from the vendor's or clinician's perspective rather than the patient's. For better patient engagement, assess whether the technology is truly usable for each individual, considering the diversity of patients and caregivers.

Using best practices will help you promote health IT literacy both within your clinical setting and with your patients. The best practices and resources below build upon and incorporate the 5 principles outlined above to aid health IT literacy and patient engagement.

Evaluation

Take steps to evaluate how health IT literacy can help improve your practice.

• For a comprehensive resource from the Office of the Assistant Secretary for Health, see Health Literacy Online: A Guide to Simplifying the User Experience.
• For a global resource, see the Digital Health Literacy Toolkit prepared by the Global Digital Health Partnership's Clinical and Human Engagement Work Stream. This toolkit was designed to support settings and individuals without significant experience in developing health IT literacy. Module 4 - Checklists and Considerations [PDF — 707 KB] may be especially helpful.

Integrated design

Involve diverse users in the initial design of user interfaces and workflows of health IT to increase both patient engagement and health IT literacy. If you build it with them, they will already be engaged and have health IT literacy. Remember, health IT literacy varies widely across users and settings, so be sure the design process considers these differences and includes the spectrum of users.

Unified implementation

Connect implementation and uptake of health IT across clinical and patient settings to boost health IT literacy across both sectors of the ecosystem. Changing health IT in one sector without considering the implications for the other can create unnecessary burdens and lead to costly adjustments. For example, as electronic health records and health systems have turned increasingly to the use of AI algorithms, bias in some AI algorithms has produced disparities in patient access and outcomes, highlighting the importance of testing for disparities and bias before implementation, and integrating procedures for monitoring and reporting such consequences for correction.

Testing, training, and monitoring

Conduct appropriate real-world testing in advance.

• Before procurement and during implementation and use, ask vendors if they have tested and validated the health IT for health IT literacy in clinical and patient-facing settings wherever relevant. Ask to see quantitative and qualitative results of real-world testing.
• Undertake initial real-world testing of patient portals, health applications, devices, and other patient-facing interfaces to match patients' and caregivers' levels of health IT literacy — and regularly monitor and assess health IT literacy thereafter.

Schedule regular workforce trainings on how to use health IT and how to mitigate the limitations of health IT, as well as tailored trainings for any minor or major updates. Consider assigning a health IT literacy champion to help flag health IT literacy issues so that you can address them proactively.

Regularly measuring and monitoring health IT use and trends as ecosystems, conditions, and patient populations change will help you consistently promote health IT literacy.

Resources

• Patient engagement: For insights from a national survey of consumers and patients, see Engaging Patients and Families: How Consumers Value and Use Health IT [PDF — 1,761 KB].
• Patient access: For resources on patient access to and use of their digital health records, see Get It, Check It, Use It: The Guide to Getting & Using Your Health Records.
• Digital content: For structuring, writing, and formatting digital health content for web- and app-based health tools to improve health literacy and health IT literacy, see Section 4: Create Actionable Content from Health Literacy Online: A Guide to Simplifying the User Experience.
• Language access: In the U.S., over 21% of people ages 5 and older speak a language other than English — such as Spanish, Chinese, Tagalog, or Arabic — at home. Around 8% do not speak English very well. For insights about helping patients and family caregivers with access to health IT in languages other than English, see Spanish-Speaking Parents' Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use, including Table 6. Even initial awareness of your practice's health IT and its benefits may depend on communicating that availability in the various languages your communities and patients use.
• Health IT navigator: For insights about how an internal health IT champion can help — as dedicated positions in larger practices or as an assigned job duty among smaller practices — see Standardising the role of a digital navigator in behavioural health: a systematic review and Landscape Assessment of Digital Navigation in the California Safety Net [PDF — 3.4 MB]. Such navigators can also help work around digital divides.

Artificial intelligence (AI) is an increasingly important part of health IT, bringing new health IT literacy considerations. Clinicians, staff, caregivers, and patients should understand the basics of AI's benefits, limitations, and appropriate uses. As innovation accelerates and the field evolves, start with these initial considerations.

Be transparent about the use of AI in your technology

AI algorithms and their underlying logic and data are often hidden from view. In light of this invisibility and ongoing national conversations about AI, transparency is essential — both in clinical settings and with patients and caregivers. Being clear about whether and how AI is used helps maintain patients' trust and encourages engagement.

Keeping in mind the various levels of health IT literacy among your clinicians, staff, patients, and caregivers, develop a communication plan including educational materials to openly and proactively communicate:

• When and how AI is being used
• What data the AI uses
• Technical aspects about the AI and how it performs
• Risks related to the AI and how those risks are managed or addressed

It's important to remember that to be transparent, your practice needs regular and consistent access to information on the AI's usage, data, performance, risks, and other technical aspects. Your practice might have this information, but your EHR vendor and your patients might also have necessary information.

Increase patient engagement by leveraging the use of AI

The National Academies of Sciences, Engineering, and Medicine's workshop brief Diagnosis in the Era of Digital Health and Artificial Intelligence highlights several opportunities to use AI to increase patient engagement, such as:

• Focusing on reaching patients and family caregivers with educational materials about what AI is, why and when it is used, and the reasons for transparency and clear notifications
• Incorporating patient and caregiver perspectives in the development and use of AI and digital health technologies to improve diagnosis
• Empowering patients to use AI and digital health tools to understand their symptoms and inform decisions throughout the diagnostic process
• Improving transparency and building trust with patients and caregivers to use AI and digital health technologies for their diagnosis

Increase health IT literacy in each step of the development process

As you research, develop, and implement AI tools within your practice setting, consider the following approaches to aid health IT literacy regarding AI:

• Investigate and ensure that the AI you're considering meets the FAVES rubric: Fair (unbiased, equitable), Appropriate, Valid, Effective, and Safe. Read more in the ONC Blog post on Increasing the Transparency and Trustworthiness of AI in Health Care.
• Review the requirements for algorithm transparency and information sharing applicable to certified health IT regulated by ONC in this Decision Support Interventions (DSI) Fact Sheet [PDF — 281 KB].
• Involve users in your practice in the design of AI tools and workflows.
• Develop and schedule regular clinician and staff trainings on how your practice uses AI, tailored to use cases and roles.
• Regularly measure and monitor the use and performance of AI.
• Report the AI system's performance and impact on health and safety, both internally and externally.

Document the measurement and monitoring process to support knowledge sharing and transparency. And update the process regularly — especially as the environments and data underlying AI algorithms change over time. Ongoing monitoring, measurement, and transparency promote a learning health system.

Resources

• The National Academy of Medicine's An Artificial Intelligence Code of Conduct for Health and Medicine: Essential Guidance for Aligned Action (2025)
• The U.S. Government Accountability Office's Artificial Intelligence in Health Care: Benefits and Challenges of Technologies to Augment Patient Care [PDF — 4.9 MB] (2020)
• Article in the Journal of Participatory Medicine: From E-Patients to AI Patients: The Tidal Wave Empowering Patients, Redefining Clinical Relationships, and Transforming Care (2025)