In 2025, U.S. digital health startups raised $14.2 billion. AI-enabled companies captured 54% of it. Every prediction in every roundup carries one quiet assumption underneath it. The patient on the receiving end can use what's being built.

The Pew data from January says something different.

Two trajectories. One looks like progress in aggregate. The other looks like the patients with the worst health outcomes being structurally locked out of the system that's being built. Chris Boyer and Reed Smith examine what happens when digital strategy and health equity stop being parallel tracks and become the same problem.

Why the 2026 AI investment narrative quietly assumes a digitally capable patient, and what the population data actually shows
The smartphone-dependent patient most health systems haven't internalized, and why portal UX fails them by design
Why disparities in patient portal access are widening for low-income, less-educated and 65-plus populations, even as overall use rises
What the 2025 cancellation of federal digital equity funding means for health systems whose patient panels actually need the work done
Modality mix as the reframe: digital, phone, in-person and printed channels as a portfolio allocated by segment, not a hierarchy everyone migrates toward

The University of Michigan study published in JAMA Network Open in October is the one to anchor on. Researchers looked at 511 hospitals in 51 counties in 17 states where census data showed at least 300,000 LEP residents. 29% of those hospitals offered the patient portal login in English only. 60% offered English plus Spanish. 11% offered three or more languages. In counties specifically chosen because they have hundreds of thousands of patients who don't speak English at home.

If your most-invested-in digital experience reaches the patients who already had the most options, and barely touches the patients with the worst outcomes, what is your digital strategy actually optimizing for?

Mentions from the Show:

Pew Research Center, NPORS 2025, January 2026: https://www.pewresearch.org/short-reads/2026/01/08/internet-use-smartphone-ownership-digital-divides-in-u-s/
Pew Research Center, Internet/Broadband Fact Sheet, December 2025: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/
Pew Research Center, Mobile Fact Sheet, December 2025: https://www.pewresearch.org/internet/fact-sheet/mobile/
OATS / Benton Institute, 19 Million Older Adults Lack Broadband, 2025: https://www.benton.org/blog/19-million-older-adults-lack-broadband
Shah & Fiala, Disparities in Patient Portal Access and Utilization, Journal of General Internal Medicine, January 2025: https://link.springer.com/article/10.1007/s11606-025-09359-z
Chen et al. (U-Michigan), Language Barriers and Access to Hospital Patient Portals in the US, JAMA Network Open, October 2025: https://ihpi.umich.edu/news-events/news/language-barriers-health-care-have-fallen-not-online-study-shows
Healthcare Dive, Top healthcare AI trends in 2026 (Rock Health funding data), January 2026: https://www.healthcaredive.com/news/top-healthcare-ai-artificial-intelligence-trends-2026/809493/
HIT Consultant / CB Insights, Q1 2026 Digital Health Funding, April 2026: https://hitconsultant.net/2026/04/20/digital-health-funding-q1-2026-ai-ma-rebound/
Chief Healthcare Executive, AI in health care: 26 leaders offer predictions for 2026, January 2026: https://www.chiefhealthcareexecutive.com/view/ai-in-health-care-26-leaders-offer-predictions-for-2026
JMIR, Bridging Rural America's Digital Divide in Health Care, December 2025: https://www.jmir.org/2025/1/e88833
Johns Hopkins Bloomberg School, Bridging the Digital Divide in Health Care: A New Framework for Equity, January 2025: https://publichealth.jhu.edu/2025/bridging-the-digital-divide-in-health-care-a-new-framework-for-equity
NPR, How ending the Digital Equity Act has disrupted programs to help people get online, November 2025: https://www.npr.org/2025/11/12/nx-s1-5594805/how-ending-the-digital-equity-act-has-disrupted-programs-to-help-people-get-online
ScienceDirect narrative review, Addressing language barriers in U.S. healthcare, November 2025: https://www.sciencedirect.com/science/article/pii/S2772632025000418
Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/
Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/
Chris Boyer website: http://www.christopherboyer.com/
Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social
Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social

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