The vision of health information technology is enticing. In a world with electronic medical records, care providers in emergency rooms at the other end of the planet would be able to access our medical history instantly. Electronic prescribing systems would automatically transmit our prescription to the local pharmacy to be filled with cost-effective drugs that pose no risk of interaction, and telemedicine would give us access to the best specialists. In short, we are promised a safe and hassle-free world where as health care consumers we are empowered to take control of our own health conditions and have the knowledge and information necessary to make considered choices.

But there is a fundamental flaw with this vision. It is built around a concept of a future patient who is affluent, well-educated and — most of all — tech-savvy. It is predicated on the ability to access and use complicated technologies and neglects groups that lag behind in this — racial and ethnic minorities, the elderly, and the less-educated. As a result, it is these individuals who will become even further distanced from the movement to transform health care. This will certainly be the case if, as a by-product of reform, technologies are used to shift the responsibility for managing disease on to patients.

Unless there is a plan for universal health care that addresses technology’s future key role in the access to care, we just may end with an even wider schism between those the system currently serves and those it fails.

Ritu Agarwal is professor and director of the Center for Health Information and Decision Systems at the University of Maryland’s Robert H. Smith School of Business. Kislaya Prasad is research professor at the University of Maryland’s Robert H. Smith School of Business and a guest scholar at The Brookings Institution.