Health Care Providers' Role In Protecting EHRs: Implications For .

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ONC Data Brief No. 15 February 2014Health care providers’ role in protecting EHRs: Implications for consumersupport of EHRs, HIE and patient-provider communicationPenelope Hughes JD MPH, Vaishali Patel PhD MPH, Joy Pritts JDAs the adoption of electronic health records (EHRs) and health information exchange (HIE)expands, and patient health information is increasingly stored and shared by providerselectronically, it is important to monitor patient trust in providers’ ability to keep thatinformation private and secure.In 2012, the Office of the National Coordinator for Health Information Technology (ONC)conducted a nationally representative telephone survey of 2,050 adult individuals, in bothEnglish and Spanish. The survey focused on their privacy and security attitudes, in particularwhen their health information is stored or transmitted electronically via EHRs and HIE. Thisdata brief reports individuals’ perceptions about the measures put in place by providers to protectEHRs, and its association with support for EHRs, HIE and patient-provider communication.84% of individuals either strongly agree or agree that health care providers havemeasures in place that provide reasonable protections for EHRs.Figure 1: National estimates of degree to which individuals’ agree that health care providers areproviding reasonable protections for EHRsSOURCE: 2012 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic HealthRecords and Health Information ExchangeNote: Excludes 6.7% of individuals who refused or responded “Don’t know” Most individuals (84%) either agree or strongly agree that providers have reasonableprotections in place for EHRs (Figure 1).1

Support for EHRs is significantly higher among individuals who agree that health careproviders have measures in place that provide reasonable protections for EHRs.Figure 2: Percentage of individuals who support electronic health records by whether they agreethat health care providers are providing reasonable protections for EHRsSOURCE: 2012 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic HealthRecords and Health Information Exchange Three-quarters of individuals (75%) express support for EHRs. Only 17% of individuals who strongly disagree that health care providers adequatelyprotect electronic health records support EHRs – compared to 87% of individuals whostrongly agree providers have adequate protections (Figure 2).2

Individuals who disagree that health care providers have measures in place that providereasonable protections for EHRs are less likely to support HIE.Figure 3: Percentage of individuals who support electronic health information exchange bywhether they agree that health care providers are providing reasonable protections for EHRsSOURCE: 2012 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic HealthRecords and Health Information Exchange Approximately three-quarters of individuals (74%) express support for HIE amonghealthcare providers treating them (Figure 3). Only about 3 in 10 individuals (29%) who strongly disagreed that health care providersprovide reasonable protections for EHRs support HIE; whereas 84% of individuals whostrongly agreed that providers have adequate protections in place support HIErespectively.3

Individuals who strongly disagree that health care providers have measures in place thatprovide reasonable protections for EHRs are more likely to withhold information fromtheir provider due to privacy or security concerns.Figure 4: Percentage of individuals who have withheld information from their provider due toprivacy or security concernsSOURCE: 2012 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic HealthRecords and Health Information Exchange Individuals who strongly disagree that health care providers have reasonable protectionsin place for EHRs are over 8 times more likely to have withheld information from theirprovider compared to those who strongly agree (33% vs. 4%) (Figure 4). Compared to the overall population, individuals who strongly disagree that health careproviders have reasonable protections in place for EHRs are almost 5 times more likely tohave withheld information from their provider (33% vs. 7%).4

SummaryONC survey results indicate that individuals’ trust in health care providers’ ability to protect theprivacy and security of their electronic health information is associated with their perceptionsregarding EHRs, HIE, and communication with their provider. A large majority ofindividuals—84%—either strongly agree or agree that health care providers have measures inplace that provide reasonable protections for EHRs. Additionally, approximately three-quartersof individuals support EHRs and HIE among providers treating them.However, the 16% of individuals who disagree that health care providers are adequatelyprotecting EHRs are significantly less likely to support both EHRs and HIE. The results showthat consumer support for EHRs decreases with lower levels of agreement that health careproviders are providing reasonable protections for EHRs. Support for EHRs drops from 87%among those who strongly agree providers provide reasonable protections to 17% among thosewho strongly disagree. Similarly, support for HIE drops from 84% among those who stronglyagree that health care providers are providing reasonable protections for EHRs to 29% amongthose who strongly disagree.Additionally, individuals’ perceptions regarding healthcare providers’ taking measures to protectEHRs are also associated with patient-provider communication. The survey examined whetherindividuals ever withheld information from their provider due to concerns about privacy orsecurity. While a modest number of patients overall responded that they had kept informationfrom their provider (7%); this increased five-fold among individuals who disagreed thatproviders were taking measures to protect EHRs.The results of ONC’s survey indicate that from the consumer’s perspective, the provider plays animportant role in ensuring reasonable protections are in place for EHRs. Consumers’ lack oftrust in providers’ protections of EHRs has the potential to impact patient-providercommunication and consumer support for health IT, including health information exchange. Theresults underscore the importance of encouraging and enabling providers to better safeguardpatients’ health information, in particular as it is stored and shared electronically.5

DefinitionsElectronic Health Records: For the purpose of the survey, the term “electronic medical records”was used to refer to such records and was defined as medical records that are created, stored andviewed on computers.Health Information Exchange: For the purpose of the survey, the concept of health informationexchange was described as health care providers using a computer to share a patient’s medicalrecords with other providers treating that patient.Data Source and MethodsData are from The Office of the National Coordinator’s (ONC) Consumer Survey of AttitudesToward the Privacy and Security Aspects of Electronic Health Records and Health InformationExchange. The survey was conducted by NORC at the University of Chicago.The respondent universe for the Survey was the civilian, non-institutionalized population ages 18years old and older within the 50 states and the District of Columbia. This survey utilized a dualrandom digit dialing (RDD) frame of landline phone numbers and wireless/mobile phonenumbers developed by Survey Sampling International (SSI). In order to reduce samplingvariability and to represent the nation, NORC stratified the landline RDD frame by CensusRegion. The Survey oversampled Hispanic and Black populations. From each household with aselected phone number in a given frame only one adult was selected to complete the telephoneinterview. The survey utilized the last-birthday respondent-selection method, asking for theeligible person (adult at least 18 years old) within the sampling unit (i.e., household) who had themost recent birthday or would have the next birthday. This method provided a true within-unitprobability sample without intrusive or burdensome screening of eligible persons in thehousehold and ensured maximum respondent anonymity, as no identifying information wascollected. For the main survey data collection, the target number of completed interviews was2,000. A total of 2,050 surveys were completed, with a response rate of 31.7%.The items used to generate analysis reported in this survey included:Have you ever kept information from your health care provider because you wereconcerned about the privacy or security of your medical record? YESNOHealth care providers have measures in place that provide a reasonable level ofprotection for electronic medical records today. Strongly agree Agree Disagree Strongly disagree6

I want my health care providers to use an electronic medical record to store and managemy health information despite any concerns I might have about privacy and security. Strongly agreeAgreeDisagreeStrongly disagreeI want my health care providers to use a computer to share my medical record with otherproviders treating me despite any concerns I might have about privacy and security. Strongly agree Agree Disagree Strongly disagreeAbout the AuthorsThe authors are with the Office of the National Coordinator for Health Information Technology,Office of the Chief Privacy Officer and Office of Economic Analysis, Evaluation and Modeling.AcknowledgementsMITRE and NORC at the University of Chicago contributed to the development of the surveyinstrument, survey administration, and data analysis.Suggested CitationPenelope Hughes JD MPH, Vaishali Patel PhD MPH, Joy Pritts JD. “Health care providers’ rolein protecting EHRs: Implications for consumer support of EHRs, HIE and patient-providercommunication.” ONC Data Brief, no 15 Washington, DC: Office of the National Coordinatorfor Health Information Technology. February 2014.7

Department of Health and Human Services, Office of the National Coordinator for Health Information Technology Subject: health care providers' role in protecting electronic health records Keywords: ONC, HIT, health information, technology, data brief, health care, providers, EHR, HIE, communcation, patient Created Date: 2/24/2014 3:43:29 PM

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