The Benefits of Electronic Medical Records Sound Good, but Privacy Could Become a Difficult Issue

ROCHESTER, N.Y. – February 8, 2007 – The potential benefits of electronic medical records (EMRs) sounds appealing to most people, but when the issue of privacy is raised, many people become concerned about the potential for privacy abuses in EMR systems. However, most have read or heard nothing about EMRs, so public opinion is waiting to be formed.

These are some of the findings of three different surveys, each of which contained some relevant questions on EMRs, which were conducted by Harris Interactive^® in 2006 and 2005. Two of these surveys were conducted with Dr. Alan F. Westin, Professor of Public Law & Government Emeritus at Columbia University and one of the world’s leading authorities on privacy issues in health care and other business and government settings.

In reviewing these results, Dr. Westin commented "Personal medical records have always been rated as highly sensitive by the American public. As programs to automate and interconnect patient medical records across the U.S. health care system proceed, it will be vital to track how patients see this affecting not only the quality and costs of health care, but also the confidentiality, privacy and security of their personal health information."

Many people know virtually nothing about the current campaign to adopt EMRs throughout the U.S. health care system. Only 29 percent claim to have read or heard anything about them. Therefore, it is important to point out that mass public opinion about EMR systems does not yet exist. How public opinion develops, as public knowledge and awareness of EMRs grow, will depend therefore on reports in the media on the advantages and disadvantages they offer.

"The Federal government has called for medical and health-care organizations to work with technology firms to create a nationwide system of electronic Medical Records over the next few years. The goal is to improve the effectiveness of patient care, lessen medical errors and reduce the high costs of paper handling. Have you read or heard anything about this program?"

Base: All Adults (September 7 to 13, 2006)

However, even though many people know little or nothing about EMR system developments, many of the potential benefits of EMRs are appealing. A majority of people agree with statements that EMRs hold out the promise of:

• Significantly decreasing medical errors (55%)
• Significantly decreasing healthcare costs (60%)
• Improving the quality of care by reducing unnecessary test and procedures (68%)

A majority also agrees with the suggestion that adoption of EMRs will make it "more difficult to ensure patients’ privacy" (62%).

"How strongly do you agree or disagree with each of the following statements?"

Base: All adults who are online (September 5 to 7, 2006)

While very few people (4% of all adults or less) currently use services to be provided by health information technology, substantial majorities of the public say they would like to be able to:

• Receive reminders to revisit their doctors online (77%)
• Communicate with their doctors by email (74%)
• Schedule appointments online (75%)
• Receive the results of diagnostic tests via email (67%)
• Use home monitoring devices, like blood pressure readings or blood tests, and send results to their doctors’ offices by telephone or email (57%)

Overall, a 64 percent majority say, when asked, that they would like to have "an electronic medical record to capture medical information."

"To what extent do you use, or have access to the following?"

"Which of the following technologies would you like to have access to when seeking care from a doctor or hospital?"

Base: All adults (September 5 to 7, 2006)

Majorities of all adults say that if they could choose between two doctors, only one of whom used electronic medical records or with whom they could communicate directly by email, that this would influence their choice at least to some extent.

These results suggest that as the health information technology revolution develops, doctors will adopt HIT and EMRs not just for the immediate value to them and their patients, but also to help them grow their practices.

"If you could choose between two doctors, but only one used the following types of information technology in his or her practice, how much would this influence your choice of doctors?"

Base: All adults (September 5 to 7, 2006)

While several aspects of health information technology and EMRs are appealing to many people, a substantial plurality (42% to 29%) of the public believes that the privacy risks of EMRs outweigh the potential benefits.

This response is surprising given that 64 percent of the public (Table 3) say, when asked, that they would like to have an EMR. This apparent contradiction can be explained by the fact that many people know nothing, and therefore presumably have no opinion, about EMRs. What we measured therefore was not public opinion so much as public reactions to ideas and benefits they had never previously thought about, but which they view in light of their general concerns about protection of the confidentiality and privacy of their sensitive medical information.

"Supporters of the new patient electronic record system say that strong privacy and data security regulations will be applied. Critics worry that these will not be applied or will not be sufficient. Overall, do you feel that the expected benefits to patients and society of this patient electronic medical record system outweigh potential risks to privacy, or do you feel that the privacy risks outweigh the expected benefits?"

Base: All adults (September 7 to 13, 2006)

When presented with a list of four choices as to how they might be notified or consulted about the transition from paper records to EMRs, there is absolutely no consensus. About one in five adults (21%) say they want to be given the right not to have their medical records entered into the new electronic systems. Just over a quarter (27%) say that they want to be notified but would probably "be okay" with this. Twelve percent say they would want to be able to designate what does or does not get entered in their EMRs. Only 22 percent say that they would not need to be notified.

"What this indicates," Dr. Westin noted, "is that over three quarters of the public – 78 percent – do not believe that organizations moving into an EMR system should treat this as just a clerical or administrative change. Rather, the public wants affected patients to be informed of how step would affect the handling of their health information and to be given various kinds of choices in the process."

"How would you like to be involved when organization providing you with health care records transition from mostly paper records to a complete electronic health record system? Please select one answer that best represents your view.

Base: All adults (September 7 to 13, 2006)

Replies to two other questions, asked in the 2005 survey, suggest that the HIPAA rules – which many people in the health care system regard as unnecessarily burdensome – have been somewhat successful in retaining public confidence and reassuring patients that their medical privacy is being protected.

Two thirds of the public (67%) remember receiving HIPAA notices from their providers or insurers. A majority of those who recall this said that the regulations and the privacy notices have increased their confidence either somewhat (44%) or a lot (23%).

This suggests that notification to patients of the transition to EMRs, explanations of their effects and communication of continued HIPAA privacy rights would help reassure the public that their privacy will not be put at risk by EMRs.

"Since 2000, a Federal Health Privacy regulation (called the HIPAA Rule) has required all health care organizations to give patients a privacy notice explaining how the organization will collect and use the patient’s health information, how it will keep the information secure, how patients can get access to their own health records, correct any errors, and control most disclosures of their information to people outside the health care system, have you ever received one of these HIPAA health privacy notices?"

Base: All adults (February 2005)

"Based on your experiences and what you may have heard, how much has this federal privacy regulation and the Privacy Notices affected your confidence that your personal medical information is being handled today in what you feel is a proper way? Has it increased your confidence?

Base: Have Received HIPAA Privacy Notices (February 2005)

This Harris Poll^® conducted three different surveys each of which contained some relevant questions on EMRs in 2006 and 2005. Two of these surveys (September 7 to 13, 2006 and February 8 to 13, 2005) were conducted with Dr. Alan F. Westin, Professor of Public Law & Government Emeritus at Columbia University and one of the world’s leading authorities on privacy issues, as they affect business and government. The third survey (September 5 to 7, 2006) was conducted with The Wall Street Journal Online.

The surveys were field September 7 to 13, 2006 (among a national online sample of 2,747 adults), September 5 to 7, 2006 (among a national online sample of 2,624 adults) and February 8 to 13, 2005 (among a national sample of 1,012 adults.)

Figures for age, sex, race, education, region and household income were weighted where necessary to bring them into line with their actual proportions in the population. For the online surveys propensity score weighting was also used to adjust for respondents’ propensity to be online.

All surveys are subject to several sources of error. These include: sampling error (because only a sample of a population is interviewed); measurement error due to question wording and/or question order, deliberately or unintentionally inaccurate responses, nonresponse (including refusals), interviewer effects (when live interviewers are used) and weighting.

With one exception (sampling error) the magnitude of the errors that result cannot be estimated. There is, therefore, no way to calculate a finite "margin of error" for any survey and the use of these words should be avoided.

With pure probability samples, with 100 percent response rates, it is possible to calculate the probability that the sampling error (but not other sources of error) is not greater than some number. With pure probability samples of 2,747 or 2,624 adults’ one could say with a ninety-five percent probability that the overall results have a sampling error of +/- two percentage points. However that does not take other sources of error into account. The online surveys are not based on a probability sample and therefore no theoretical sampling error can be calculated.

The theoretical sampling error of the telephone survey of 1,012 adults is +/- three percentage points.

Harris Interactive is the 12^th largest and fastest-growing market research firm in the world. The company provides innovative research, insights and strategic advice to help its clients make more confident decisions which lead to measurable and enduring improvements in performance. Harris Interactive is widely known for The Harris Poll, one of the longest running, independent opinion polls and for pioneering online market research methods. The company has built what it believes to be the world’s largest panel of survey respondents, the Harris Poll Online. Harris Interactive serves clients worldwide through its United States, Europe and Asia offices, its wholly-owned subsidiary Novatris in France and through a global network of independent market research firms. The service bureau, HISB, provides its market research industry clients with mixed-mode data collection, panel development services as well as syndicated and tracking research consultation. More information about Harris Interactive may be obtained at www.harrisinteractive.com.

Jennifer Cummings
Harris Interactive
585-214-7720