Authors: Taylor Rapson, Magaly Ramirez, Sandy He, Jeanette Wong, Hyunjin Cindy Kim, Isabel Luna, Andersen Yang, Junhong Li, Paul A Fishman, James D Ralston, Courtney R Lyles, Elaine C Khoong

Digital health tools such as patient portals and telemedicine are increasingly embedded in care delivery, yet many older adults face challenges using them effectively. In a mixed methods study of 64 patients across San Francisco Health Network clinics (mean age 62 years), researchers assessed fundamental digital skills and observed participants completing common tasks such as joining a video visit, logging into a portal, and signing up for an account. While most participants could complete basic tasks like joining a video visit (74%) and logging in (71%), fewer were able to navigate to websites (52%), highlighting gaps in foundational skills. Common barriers included difficulties with text messaging workflows, confusion around URLs and links, and challenges with password creation and error recovery. These findings underscore how usability issues and limited digital literacy intersect to hinder successful engagement with digital health tools, pointing to the need for user-centered design and tailored support to improve access and equity in digital care.