OBJECTIVES: At present, the digital divide is generally considered a problem of access. This perspective is perpetuated by several assumptions regarding the availability, usability, and content of current health information and technological communications (ICT) promoting chronic care management. These biases serve to limit benefits of health technology innovation among the medically underserved or at-risk patient populations. Most prominent, the myths of ready access and sustained engagement are presented - both of which differentially expose already vulnerable groups to fewer technological advances to improve patient care readily available to other groups in addition to poorer quality information to base medical decisions upon, thus reinforcing disengagement and potentially widening the divide. METHODS: By drawing on a range of literatures, including health communications, medical informatics, social determinants of health, health behavior and promotion, the purpose of this work is to deconstruct the divide, describe its importance and impact in health care settings, in an effort to improve understanding of its role in medication adherence and patient engagement in order to inform tailored intervention development. RESULTS: Specifically, this conceptual work describes elements and challenges assumptions driving the divide in order to: expand understanding of the digital divide in practice, recognize important patient groups are being negatively impacted, and increase awareness of eHealth literacy and efficacy that may directly impact adherence and patient engagement. Examples of patient-centered technology tools are provided, such as the Personal Health Record (PHR), illustrating the potential for reducing as well as increasing the digital divide; if features of the divide are not considered when developing technologically-based behavioral interventions, those relying on health ICT may serve to amplify inequalities in health and healthcare. CONCLUSIONS: Conclusions elucidating the elements upon which patient-centered interventions may be tailored appropriately are offered, providing suggestions to inform both population-based as well as individual-based health management strategies.