NYC Consumer Attitudes towards
Electronic Health Records
A Qualitative Analysis
Edward Wu, MD, MBA, MS1
Kathryn LaSorsa, MS2
Farzad Mostashari, MD, MSc2
1NYU
School of Medicine; 2NYC Department of Health and Mental Hygiene
Research support:
NYC Department of Health and Mental Hygiene & CDC T01 CD000146
Aims
• Characterize health consumer attitudes
(risks and benefits) toward electronic
health records
• Understand the impact of increased
awareness on consumer attitudes
• Inform policy recommendations
Why study the health consumer?
Rationale for Studying Consumers
• Consumers can increase demand for EHR
– Influence physician decision to implement
– Prefer physicians who use EHRs
• Consumers can decrease demand for EHR
– Privacy concerns may impede adoption
Consumer values and concerns are key
to maximizing EHR adoption
Background
• Little is known about how consumers
perceive the risks and benefits of EHRs
• Low public awareness of EHR
– Patients: 57% report their physicians use a
computerized record
– Physicians: 24% of physicians use EHRs
Kaiser Permanente Poll 2007; National Ambulatory Medical Care Survey 2006
Research Question:
How does increased
consumer awareness impact
perceived risks and benefits?
Conceptual Model
Increased
Awareness
Perceived
Risk
-
Perceived
Benefit
+
Consumer Support for
Provider Adoption of EHR
Methods: Population
• Study population
– Respondents from the random-digit dialed
2005 NYC DOHMH Community Health Survey
– Willing to be contacted for further studies
• Screening criteria
– Seen by a physician in the past 12 months
Methods: Interview
• 40 Semi-structured telephone
interviews conducted by DOHMH
– 33 Interviews Analyzed
– 90 Open and closed ended questions
– Duration of interview: 60 mins
• Qualitative study
– Grounded theory approach
– Content analysis
Rationale for Qualitative Methods
• Exploratory, not explanatory
• Rich, detailed responses can
communicate more accurate concerns
• Traditional surveys limited by low
awareness - subject to wording bias
• Semi-structured interview process raises
awareness - informs research question
Methods: Interview topics
•
•
•
•
•
Paper-based health records
Electronic health records
Privacy issues
Patient-provider communication
Public health surveillance
Demographics: Age & Internet Use
Demographics: Race/Ethnicity
Demographics: Education
Demographics: Health Status
Themes:
Perceived Benefits and Risks
•
•
•
•
Convenience
Quality
Access Rights
Privacy
Convenience
Convenience for
the Consumer
Convenience for
the Provider
• Flexibility
• Time
• Continuity of Care
• Legibility
• Flexibility
• Efficiency
• Continuity of Care
• Sharing records
Convenience for
the Consumer
• Flexibility
• Time
• Continuity of Care
• Legibility
“…
“I
“Electronic
was
patient
in the
files
records
ER,goand
from
would
had
the
to
befloor
visit
great
to
my
–the
it
doctor
ceiling.
the
would
next
help
EHR
day.me
might
My
legibly
doctor
be a
decipher
time
had all
saver…
what
the you
he’s
don’t
information,
sayinghave
about
toand
wait
me.”
I2
didn’t
hours
have
for the
to repeat
doc.” it
all.”
Convenience for
the Provider
• Flexibility
• Efficiency
• Continuity of Care
• Sharing Records
“Using
“My
“Being
doctors
computerized
able to
would
transfer
berecords
able
my records
to would
access
with
be great
the
information
click
if
a doctor
of a button
–easier,
any must
doctor
andbeperhaps
– much
needed
more
I could
to see
cut down
convenient
me
in the on
ER.”
and
visits.”
efficient for my doctor.”
Themes:
Perceived Benefits and Risks
• Convenience
• Quality
• Access Rights
• Privacy
Quality
Accuracy & Errors
• Verification
• Fixing errors
• Typos
• Entry effort
Durability
Communication
• Longevity
• Backups
• Interaction quality
• Satisfaction
Quality
Accuracy & Errors
• Verification
• Fixing errors
• Typos
• Entry effort
“Viewing
“The
“…entering
computer
mysomething
record
would
electronically
have
into amore
computer
complete
would
information
introduces
allow
me toanother
which
verify what
could
source
my
prevent
ofdoctor
error.”
a is
misdiagnosis
saying
and bring
– it’sany
a better
errorsrecord
to him.”
for the
doctor.”
Quality
Quality
Durability
• Longevity of information
• Backups
“Ifthink
“I
there’s
you
a fire,
mustan
have
electronic
a paperrecord
backup
would
somewhere…
last,
since it’s probably
if you justbacked
rely onup
electronics, we’re
somewhere
else. gonna
Paper can
be in
bedeep
moreshit
someday -- absolutely.”
fragile.”
Quality
Communication
• Information Quality
• Satisfaction
“If Ithe
“The
communicate
computer
doctor had
might
all
with
the
make
the
facts
doctor
thestraight
doctor more
with
a electronic record,
impersonal,
electronically,
since
I don’t
they
we
feel
would
would
like always
I’m
have
always
a be
better conversation.”
typing.”
interrupting.
He can get back to me
whenever.”
Themes:
Perceived Benefits and Risks
•
•
•
•
Convenience
Quality
Access Rights
Privacy
Access Rights
Consumer
• Ability to access
• Legal right to access
Others
• Timeliness of access
• Continuity of care
• Public health
• Research entities
“You
“Definitely,
“The
“I
think
only
must
mypeople
have
my
records
family
access
I mind
can
needs
to
help
looking
your
access
themedical
at
DOH.
my
to my
I
records.
records,
records
would
want
are
in
You
case
my
them
paid
employer
I can’t
to
fornotify
it communicate.
– and
you
anyone,
should
the
have
it whencomputers
Maybe
insurance
including
you
me,
company.”
want.”
if anything
would help.”
was wrong.”
Themes:
Perceived Benefits and Risks
•
•
•
•
Convenience
Quality
Access Rights
Privacy
Privacy concerns of EHR
•
•
•
•
•
More worry with increased adoption
Fear of prosecution
Identity theft
Ease of access
Volume of accessible information
Privacy
Privacy
Privacy
“My biggest concern would be the
availability of my records to all those out
there who shouldn’t be looking.”
“Privacy is my number one concern.”
“I like electronic records, but I don’t want
people harmed by privacy breaches.”
“If we want electronic records, we definitely
have to deal with privacy issues.”
Privacy: Sharing Information
“How would you feel if information from your doctor
visit or emergency room was shared with…”
% Would Share
Another Treating Physician
100
A member of your family
94
Employer
34
Privacy: Sharing Information
“If this information was shared without revealing
anything about your personal identity to…”
% Would Share
Department of Health to keep track of the
health of New Yorkers?
94
Scientific community for medical research?
64
A federal or national data warehouse?
61
Results:
Overall Opinions of Consumers
EHR Benefits outweigh concerns
61%
EHR adoption should be a high
priority for the Department of Health
61%
Conceptual Model
+
-
Increased
Awareness
+
Perceived
Risk
-
Perceived
Benefit
+
Consumer Support for
Provider Adoption of EHR
Policy Recommendations
• Increase patient awareness of EHRs
– Emphasize perceived benefits
• Convenience, Access, Continuity of Care
– Address perceived risks
• Distractions to patient encounter
• Privacy concerns
• Address privacy concerns
–
–
–
–
Patient and provider education
Industry standards
Vendor product development
Formal practice guidelines
Study Limitations
• Qualitative – biases of investigators
• Sample size
• Generalizability
Next Steps
• Quantitative surveys informed by this
study
• Post-EHR Adoption Studies
– Perceived benefits and risks after
experience
– Impact of EHRs on physician-patient
encounter