Uiversity of Nebraska - Licol DigitalCommos@Uiversity of Nebraska - Licol Publicatios of the Uiversity of Nebraska Public Policy Ceter Public Policy Ceter, Uiversity of Nebraska 12-11-2008 Sharig Health Records Electroically: The Views of Nebraskas Tarik Abdel-Moem Uiversity of Nebraska - Licol, tabdelmoem2@ul.edu Mitchel Heria Uiversity of Nebraska - Licol, mheria2@ul.edu Follow this ad additioal works at: http://digitalcommos.ul.edu/publicpolicypublicatios Part of the Public Policy Commos Abdel-Moem, Tarik ad Heria, Mitchel, "Sharig Health Records Electroically: The Views of Nebraskas" (2008). Publicatios of the Uiversity of Nebraska Public Policy Ceter. 36. http://digitalcommos.ul.edu/publicpolicypublicatios/36 This Article is brought to you for free ad ope access by the Public Policy Ceter, Uiversity of Nebraska at DigitalCommos@Uiversity of Nebraska - Licol. It has bee accepted for iclusio i Publicatios of the Uiversity of Nebraska Public Policy Ceter by a authorized admiistrator of DigitalCommos@Uiversity of Nebraska - Licol.
Sharig Health Records Electroically: The Views of Nebraskas December 11, 2008 Tarik Abdel-Moem Mitchel Heria
The Uiversity of Nebraska Public Policy Ceter provides assistace to policymakers i all three braches of govermet ad researchers o a wide rage of public policy issues. The missio of the PPC is to actively iform public policy by facilitatig, developig, ad makig available objective research ad aalyses of issues for elected ad appoited officials; state ad local agecy staff; the public at large; ad others who represet policy iterests. 215 Ceteial Mall South, Suite 401, Licol, NE 68588-0228 Ph: 402-472-5678 Fax: 402-472-5679 www.ppc.ebraska.edu
Table of Cotets Ackowledgmets... ii Executive Summary... 1 Sharig Health Records Electroically: The Views of Nebraskas... 2 Nebraskas are Comfortable with Sharig Medical Iformatio Electroically.. 3 Nebraskas Have a Basic Level of Experiece with... 4 Iformatio Techology ad Healthcare... 4 Nebraskas Wat More Cosumer Educatio about... 4 Electroic Sharig of Health Iformatio... 4 Nebraskas Have Cocers with Network Vulerabilities... 5 Nebraskas Prefer a Idirect Role for State Govermet i Facilitatig the Sharig of Electroic Health Iformatio... 6 Recommedatios for Further Research... 7 Appedix A: Methods ad ResultsAppedix... A-1 Appedix B: Deliberative Discussio Methods ad Results... B-1 i
Ackowledgmets This project was primarily supported through a Commuity Techology Fud/eHealth grat provided by the Nebraska Iformatio Techology Commissio, whose support for egagig members of the public about ehealth policy drove this project. Members of the Commissio, the ehealth Coucil, ad Nebraska Health Iformatio Security ad Privacy Committee provided critical advice ad expertise at every level of the project. I particular, we would like to thak Lieuteat Goveror Rick Sheehy, Deis Beres, Ae Byers, Harris Frakel, Kimberly Galt, David Lawto, Kare Paschal, Nacy Shak, Ala Tomkis, ad Sheila Wrobel for their guidace ad support. We also thak Bill Kelly of NET Televisio for servig as moderator of the deliberative discussio, ad Kathy Kroe, Kathy Castle, Joshua Ewalt, Shiree Ghorbai, ad Sarah Steimel of the Uiversity of Nebraska-Licol Departmet of Commuicatio Scieces, for their assistace i facilitatig the deliberative discussio. ii
Executive Summary I November of 2008, the Uiversity of Nebraska Public Policy Ceter implemeted a public iput project to gather iformatio from Nebraskas about electroic sharig of medical iformatio. Oe hudred ad sixty eight Nebraskas completed a olie or paper copy survey, ad 34 of those survey respodets also participated i a deliberative discussio. Comfortable with Sharig Medical Iformatio Electroically Nebraskas have positive views about electroic sharig of medical iformatio. Nebraskas uderstad the beefits of electroic health iformatio exchage. Nebraskas have cocers about who should have the authority to access their electroic health iformatio. Experieced with Iformatio Techology ad Healthcare Nebraskas already have moderate levels of experiece with usig techology to fid health ad isurace iformatio. Nebraskas have little experiece with usig techology to commuicate directly with healthcare providers, though they support the cocept of electroic commuicatio with healthcare providers. Wat More Cosumer Educatio about Electroic Sharig of Health Iformatio Nebraskas see a role for State govermet i educatig citizes about the use ad sharig of electroic medical records. Educatio ca icrease levels of kowledge about the issues surroudig the use ad exchage of electroic health iformatio. Educatio ca have a positive impact o Nebraskas perceptios of the use ad sharig of electroic health iformatio. Cocers with Network Vulerabilities Nebraskas are cocered about etwork vulerabilities that would compromise security of electroic health records. Nebraskas are ot overly cocered with improper access of electroic medical records by isurace compaies, employers, etc. Prefer a Idirect Role for State Govermet i Facilitatig the Sharig of Electroic Health Iformatio Nebraskas wat State govermet to educate citizes ad esure that the electroic sharig of medical records is doe i a safe ad secure maer. There was a relatioship betwee frequecy of healthcare visits ad attitudes about the role of govermet i electroic health iformatio exchage. 1
Sharig Health Records Electroically: The Views of Nebraskas Health iformatio techology offers the potetial for positive chages i healthcare ad health outcomes i Nebraska. Electroic sharig of medical records holds sigificat potetial because of its implicatios for healthcare quality ad cost efficiecy. Yet there are may challeges. The successful use ad exchage of electroic medical iformatio is cotiget upo a viable iformatioexchage ifrastructure, a supportive policy ad regulatory eviromet, ad cooperatio amog healthcare providers, isurace compaies, iformatio techology vedors, ad other etities. Perhaps most importatly, the success of electroic health iformatio exchage is depedet upo acceptace from cosumers. Residets of Licol/Lacaster Couty gathered to ask questios ad provide iput about electroic medical records at the Deliberative Discussio held November 17, 2008, at the Uiversity of Nebraska-Licol campus. The Uiversity of Nebraska Public Policy Ceter (PPC) orgaized a public iput project to gather iformatio ad perspectives from Nebraska residets about the electroic sharig of medical iformatio. The project was supported by a Commuity Techology Fud/eHealth grat provided by the Nebraska Iformatio Techology Commissio. The overall goal of the public iput project was to lear about cosumers attitudes towards electroic sharig of medical iformatio; related cocers about privacy, access, ad security; ad opiios about what the policy role of the State of Nebraska should be i the developmet of electroic health iformatio exchage i the state. The PPC obtaied iformatio from Nebraskas i two ways. First, the PPC surveyed a radomly-selected sample of state residets about electroic iformatio sharig ad related topics. From November 5 to November 14, 2008, 168 idividuals completed the survey either olie or through mailed paper copies. Secod, o November 17, 2008, the PPC brought together 34 of the same residets i a deliberative discussio to discuss issues related to the electroic sharig of medical records. Before the deliberative discussio, participats were set a educatioal documet. At the deliberative discussio, the participats listeed to a presetatio about electroic sharig of medical iformatio, discussed their views with each other, ad iteracted with a pael of experts before completig aother survey about the topic. More details o both of these methods, as well as the results, are preseted i Appedix A (survey) ad Appedix B (deliberatio). 2
Nebraskas are Comfortable with Sharig Medical Iformatio Electroically Nebraskas have favorable views about electroic sharig of medical iformatio ad uderstad its beefits. Nebraskas are cocered, though, about the authorizatio for release of electroic health iformatio. Large majorities of survey respodets agreed that electroic sharig of medical records ca decrease What excites us is beig able to medical errors (81%), reduce patiet wait times ad travel with health iformatio, ad documetatio errors (77%), reduce healthcare costs improvemets i commuicatio (71%), ad believe that the overall beefits of usig betwee providers, but also eve electroic medical records outweigh the risks (69%). withi a hospital itself. Over 50% of survey respodets also agreed that the ability to share iformatio amog multiple providers - Deliberatio Participat was the primary beefit of sharig electroic medical records, ad about 44% of survey respodets felt that a computer record system is more secure tha paper records. Accordigly, survey respodets appeared to support their providers adoptio of electroic records. Whe preseted with a hypothetical situatio where two physicias had the same exact qualificatios, but used differet records systems, 43% of respodets would choose to go to the doctor with a electroic records system, whereas oly 5% would choose the physicia with a paper oe. However, a plurality of respodets (52%) were udecided, suggestig that there may still be reservatios about electroic sharig of medical records with some idividuals. Nebraskas were somewhat divided o questios of who should be authorized to release electroic medical iformatio. I priciple, survey respodets strogly favored havig access to their persoal electroic medical records cotrolled by their physicias (90%), but fewer respodets (47%) agreed that explicit approval from the cosumer should be required before healthcare providers share iformatio with each other. Oly 37% agreed that My healthcare providers should be able to share iformatio about my health with each other without my approval. These fidigs suggest Nebraskas are comfortable with sharig electroic medical records, but there is ot a clear cosesus about who should have the authority to permit electroic sharig of those records. 3
Nebraskas Have a Basic Level of Experiece with Iformatio Techology ad Healthcare Nebraskas regularly use the iteret to access health or isurace iformatio. They also idicate that may of their primary care providers are usig electroic records. However, ot may Nebraskas have used the iteret to commuicate directly with their providers through email, although they would like to. Nebraskas regularly use the iteret to access health iformatio, with 85% of survey respodets idicatig that they have used the iteret to search for iformatio about a health coditio or disease, ad 45% idicatig that they had used a health isurace compay s website to lear more about coverage or claim status. However, fewer Nebraskas have used the iteret to commuicate directly with healthcare providers. Oly 23% of respodets, for example, had used email to commuicate with a healthcare professioal directly, although early 70% thought cosumers should be able to email healthcare providers as part of their overall care. Lt. Goveror Rick Sheehy addressed participats at the Deliberative Discussio. Nebraskas reported that their healthcare providers at least partially use electroic medical records. A plurality of survey respodets (50%) reported their primary healthcare provider used both a paper ad computer-based medical records system. Eightee percet (18%) reported that their primary care provider oly used computer records, ad 17% reported their doctor oly used paper records. Nebraskas Wat More Cosumer Educatio about Electroic Sharig of Health Iformatio Nebraskas wat State govermet to take a leadig role i educatig citizes about the use ad sharig of electroic health iformatio. Moreover, cosumer educatioal efforts ca have a positive impact o kowledge about electroic medical record issues, ad icrease their favorability amog cosumers. Nebraskas would like to see State govermet take a active role i providig cosumer educatio about electroic sharig of medical iformatio. Sevety-two percet (72%) of the deliberatio participats said it was very importat for the State govermet to educate Nebraskas about electroic health iformatio exchage. Educatio ca icrease kowledge of the issues. Deliberatio participats were asked two idetical factual questios i the origial survey ad at the ed of the deliberatio ( How may small physicia practices curretly use electroic medical records? ad What is the Federal law that covers the security ad privacy of electroic medical records? ) to test whether the iformatio provided to them prior to the deliberative evet icreased kowledge. For both questios, the percetage of respodets who correctly aswered each questio icreased from 40% to 66% (small physicia practices) ad 45% to 70% (Federal law). 4
Cosumer educatio may also foster favorable attitudes towards electroic sharig of medical iformatio. After participatig i the deliberatio where a expert pael discussed the pros ad cos of electroic health iformatio exchage 63% of participats believed computerbased records were more secure tha paper records. This was a substatial icrease from the 44% of survey respodets who believed a computer-based records system better preveted improper access to persoal iformatio tha a paper oe. Similar icreases i favorable attitudes towards electroic sharig of health iformatio were see followig the deliberative discussio. The percetage of idividuals agreeig that the use of electroic records reduces patiet costs icreased from 58% to 97%, ad the percetage who agreed that electroic records make it easier to esure patiet privacy icreased from 45% to 81%. Nebraskas Have Cocers with Network Vulerabilities Nebraskas believe electroic records systems are geerally secure. They are cocered, however, with potetial vulerabilities of their electroic records to uauthorized access. There is less cocer with iappropriate use of their health iformatio by healthcare providers, isurace compaies, ad employers. Pleary paelists at the Deliberative Discussio (L to R): Nacy Shak of the NU Public Policy Ceter, Lt. Gov. Rick Sheehy, Dr. Harris Frakel of the Nebraska Health Iformatio Iitiative, ad Dr. David Lawto of Nebraska Health ad Huma Services. Nebraskas are geerally comfortable with the security of electroic medical records. Nearly two-thirds (63%) of the deliberatio participats idicated they believed that electroic medical records best prevet improper access to medical iformatio, compared to oly 9% who thought paper records were more secure. 5
There are still security cocers however. Asked what the biggest potetial problems were with electroic health iformatio exchage, survey respodets idicated they were most cocered with etwork vulerabilities such as computer hackig (35%) ad iteret or commuicatio outages (33%). Nebraskas were less worried with misuse of their The cocers we had were the broad security ad privacy issues... the reliability of the system if it were to go dow, ad how errors i records would be dealt with. - Deliberatio Participat electroic health iformatio. Oly small umbers of survey respodets were cocered with iappropriate use of their health iformatio by their employers (12%), isurace compaies (8%), or healthcare providers (4%). Nebraskas Prefer a Idirect Role for State Govermet i Facilitatig the Sharig of Electroic Health Iformatio There was o strog preferece for direct govermet activity i ecouragig the use ad sharig of electroic medical records. However, deliberatio participats supported a role for govermet i cosumer educatio, ad esurig the security ad privacy of medical iformatio. Cosumer support for govermet activity may be related to how frequetly idividuals seek healthcare. About half the survey respodets (52%) idicated State govermet should have a role i ecouragig doctors to use electroic medical records. A slightly smaller amout of respodets (48%) believed that the State should have a role i ecouragig isurace compaies to use electroic medical records. There was somewhat less support for Federal govermet ivolvemet. Forty-five percet (45%) ad 41% of respodets respectively thought the Federal govermet should have a role ecouragig doctors ad isurace compaies to electroically share medical iformatio. Large percetages of deliberatio participats felt it was very importat for State govermet to esure the privacy ad security of health iformatio (84%), ad provide iformatio to cosumers about health iformatio security ad privacy (72%). There was also support for the State to facilitate public-private parterships to exchage health iformatio (59%), ad regulate health iformatio etworks (53%). Relatively small percetages felt that it was very importat for State govermet to provide icetives (9%) or grats (9%) to ecourage or to require the use of electroic records systems. May of the group members seemed to thik that the govermet could be trusted to do a good job, but there was a vocal miority that expressed a strog aversio to govermet ivolvemet. - Kathy Castle, Deliberatio Facilitator Idividuals who iteract with health providers more frequetly may be less iclied to support a role for govermet i ecouragig electroic health iformatio exchage. For example, idividuals who visited their primary care physicia oce or o times i the past 6
year were more likely to support a role for State govermet (65%) i ecouragig doctors to use electroic medical records tha those who visited their primary care physicias two or more times last year (41%). Thus, there may be a relatioship betwee frequecy with which idividuals visit healthcare providers, ad the degree of support they have for a govermet role i electroic sharig of medical iformatio. Recommedatios for Further Research Fidigs from this public iput project idicate that Nebraskas are geerally comfortable with ad supportive of electroic medical records ad iformatio exchage, ad uderstad the beefits of electroic sharig of health iformatio. Nebraskas also use iformatio techology to gather iformatio about health ad health isurace. Nebraskas are, however, somewhat cocered with security ad privacy issues surroudig electroic health iformatio exchage. A cosumer educatio effort may icrease uderstadig ad support for greater electroic health iformatio exchage, ad Nebraskas would welcome a State govermet role i providig educatio to the public about these issues. Additioal research with a expaded sample size should be doe to further examie Nebraskas attitudes towards these ad related issues. Particular iquiries should be made ito cosumer prefereces regardig authorizatio for release of electroic health iformatio, ad the relatioship betwee how frequetly cosumers visit healthcare providers, ad the degree of support they have for govermet ivolvemet i electroic health iformatio exchage. Participats i the November 17th discussio deliberated about security, privacy, ad policy issues related to electroic sharig of medical iformatio i small group sessios. 7
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Appedix A: Methods ad Results A-1
Appedix A: Methods ad Results Methods The survey was developed by the Public Policy Ceter i cosultatio with a workig group composed of members of Nebraska s ehealth Coucil a advisory committee created by the Nebraska Iformatio Techology Commissio to make recommedatios about electroic health techologies ad the Health Iformatio Security ad Privacy Committee (HISPC) a advisory committee which focuses o health iformatio security ad privacy cocers. The workig group also provided cosultatio o overall project desig. The Uiversity of Nebraska-Licol Istitutioal Review Board provided review ad approval of the study. The PPC targeted residets of Nebraska from three differet areas to participate i the survey: 1) Licol/Lacaster Couty; 2) Omaha/Douglas Couty; ad 3) a six-couty area i cetral Nebraska surroudig Kearey (Adams, Buffalo, Dawso, Hall, Kearey, ad Phelps). Prospective survey respodets were cotacted by letter through postal mail by the PPC. Cotact iformatio was obtaied from lists derived from radom digit dialig or publicly available residetial addresses obtaied by the PPC i previous public opiio projects. A estimated 1,610 households were cotacted by a mailed letter, ivitig prospective respodets to complete the survey olie. Idividuals who preferred to complete a paper versio of the survey had the optio of cotactig the PPC ad requestig that a paper copy be set to them with a busiess reply evelope. Staff from the PPC also telephoed 282 prospective respodets ad ecouraged them to complete the survey. A total of 168 respodets participated i the survey either olie or through a paper hard copy, although ot all respodets aswered every survey item. A-2
Olie Results Kowledge ad Experiece Table 1 Have you ever doe ay of the followig thigs before? Yes No Used the iteret to fid iformatio about a particular illess or disease? Used email to commuicate with a healthcare professioal? Used a health isurace compay s website to lear more about your healthcare coverage or check o the status of a claim? 138 84.8 15.2 137 23.4 76.6 137 44.5 55.5 Table 2 To the best of your kowledge, what type of medical records system does your primary healthcare provider use? Percet A paper record system 24 17.4 A computer record system 25 18.1 Both 69 50 Not sure 19 13.8 I do t see ay health providers 1.7 Total 138 100 Table 3 Compared to the average perso, how kowledgeable do you thik you are about health iformatio security ad privacy issues? Percet I kow much less tha the average perso 5 3.6 I kow less tha the average perso 16 11.7 I kow about the same as the average perso 71 51.8 I kow more tha the average perso 35 25.5 I kow much more tha the average perso 10 7.3 Total 137 100 A-3
Table 4 What is your best aswer to the followig questios? Natioally, approximately how may small physicia practices curretly use electroic medical records? Percet Less tha 5% 20 14.6 Betwee 5%-35% 55 40.1 Betwee 36%-50% 37 27 Betwee 51%-75% 22 16.1 Betwee 76%-90% 3 2.2 Total 137 100 The federal law that covers the security ad privacy of electroic medical records is: The Medical Iformatio Exchage Act The Electroic Fraud ad Abuse Prevetio Act Percet 11 8.1 8 5.9 The Patiet s Bill of Rights Act 22 16.3 The Health Iformatio Portability ad Accoutability Act There is o federal law that covers the security ad privacy of electroic medical records 61 45.2 33 24.4 Total 135 100 A-4
Table 5 Approximately how may times have you visited the followig types of healthcare providers i the past year? No times Oce 2-3 times 4-6 times 7 or more times Primary care physicia 132 14.4% 28% 40.2% 15.9% 1.5% Emergecy room provider 133 80.5% 17.3% 1.5% -.8% Obstetrics or Gyecology 134 85.8% 12.7% 1.5% - - Nurse practitioer 129 80.6% 8.5% 8.5% 1.6%.8% Physicia s assistat 130 65.4% 16.9% 14.6% 3.1% - Specialist (cardiology, ocology, psychiatry, rheumatology, orthopedics, geeral surgery, etc.) 133 45.9% 22.6% 22.6% 6% 3% Other 117 63.2% 15.4% 13.7% 5.1% 2.6% Table 6 Experiece i the Healthcare Idustry Are you curretly employed by a healthcare orgaizatio or health or life isurace compay? Have you worked i ay area of healthcare i the past? Have you ever bee formally traied or educated i some aspect of healthcare? Yes No 137 13.9% 86.1% 135 33.3% 66.7% 136 37.5% 62.5% A-5
The Role of Govermet Table 7 What should be the role of Govermet whe it comes to electroic medical records ad the electroic sharig of iformatio? Do you feel that the federal govermet has a role i ecouragig doctors to use electroic medical records? Do you feel that the federal govermet has a role i ecouragig isurace compaies to use electroic medical records? Do you feel that the Nebraska state govermet has a role i ecouragig doctors to use electroic medical records? Do you feel that the Nebraska state govermet has a role i ecouragig isurace compaies to use electroic medical records? Yes No 135 45.2% 54.8% 134 41% 59% 134 51.5% 48.5% 133 48.1% 51.9% Table 8 Uder curret Nebraska state law, idividuals must re-authorize release of their electroic medical records to healthcare providers every 180 days. Do you thik that this 180 day period should be: Decreased to a shorter amout of time (people will have to re-authorize release of their records more frequetly) Exteded to a loger amout of time (people will have to re-authorize release of their records less frequetly) Percet 1.7 34 25 Left the same 34 25 Chaged to require authorizatio by idividuals aytime their electroic medical record is accessed The time limit should be removed (people could choose whe their authorizatio period expires) 16 11.8 21 15.4 Not sure 30 22.1 Total 136 100 A-6
Figure 1 Figure 2 A-7
Figure 3 Figure 4 A-8
Opiios of ad Cofidece i Electroic Medical Records Table 9 I your opiio, which type of medical records system do you believe best prevets improper access? Percet A computer record system 60 43.5 A paper record system 43 31.2 Not sure 35 25.4 Total 138 100 Table 10 If two doctors had exactly the same qualificatios, but oe used a electroic record system ad the other did ot, which ONE would you choose? The doctor usig a electroic record system The doctor NOT usig a electroic record system Percet 59 42.8 7 5.1 Not sure 72 52.2 Total 138 100 Table 11 How cofidet are you that whe you go to see a healthcare professioal, he or she has a accurate ad complete picture of your ecessary medical iformatio ad prior medical history? Percet Very cofidet 38 27.7 Somewhat cofidet 68 49.6 Not very cofidet 18 13.1 Not at all cofidet 8 5.8 Not sure 5 3.6 Total 137 100 A-9
Table 12 The followig is a list of potetial beefits of electroic medical records. Which ONE is the most importat potetial beefit to you? Percet Better treatmet i a emergecy 26 18.8 Icreased efficiecy i healthcare resultig i decreased costs A icrease i the ability of healthcare providers to share ad review the same patiet records ad work together to deliver better care 15 10.9 70 50.7 Reductio i medical errors 10 7.2 Persoal access to ad cotrol of my ow health record 12 8.7 Noe of these 2 1.4 Not sure 3 2.2 Total 138 100 Table 13 The followig is a list of potetial problems with electroic medical records. Which ONE do you thik creates the greatest problem? A iteret or commuicatio outage makes my records uavailable A hacker bypasses security ad steals my persoal data My healthcare providers lear about my health iformatio whe it is ot ecessary for them to kow it My health isurace compay lears about my health iformatio whe it is ot ecessary for them to kow it My employer lears about my health iformatio whe it is ot ecessary for them to kow it Percet 45 32.6 48 34.8 6 4.3 17 12.3 11 8 Noe of these 5 3.6 Not sure 6 4.3 Total 138 100 A-10
Table 14 How strogly do you agree or disagree with each of the followig statemets? The use of electroic medical records ca decrease medical errors. The use of electroic medical records ca reduce healthcare costs. The use of electroic medical records makes it easier to esure patiets privacy. The use of electroic medical records ca improve the quality of care patiets receive by reducig patiet wait times ad errors i documetatio. The use of electroic medical records ca lower my healthcare costs by reducig uecessary tests ad procedures. If doctors ad researchers were able to share iformatio more easily via electroic medical systems; patiets could receive better care based o curret scietific kowledge. Patiets should have access to their ow electroic medical record maitaied by their physicia. Patiets should have access to their ow electroic medical record through a orgaizatio ot liked with their providers. Medical offices should provide patiets with the ability to schedule appoitmets via email or o the iteret. Patiets should be able to email their doctors as part of their overall care. The beefits of electroic medical records outweigh the risks. Doctors should be compesated for time spet coectig with patiets by phoe or electroic systems. Agree strogly Agree somewhat Disagree somewhat Disagree strogly Not sure 137 28.5% 52.6% 8.8% 2.9% 7.3% 137 20.4% 50.4% 10.9% 3.6% 14.6% 135 11.9% 32.6% 25.9% 8.1% 21.5% 137 30.7% 46.7% 5.8% 5.1% 11.7% 137 20.4% 38% 19.7% 7.3% 14.6% 135 40.7% 45.2% 4.4%.7% 8.9% 135 61.5% 28.1% 5.9% 1.5% 3% 135 16.3% 25.2% 17.8% 24.4% 16.3% 135 27.4% 39.3% 14.8% 7.4% 11.1% 135 29.6% 40% 15.6% 6.7% 8.1% 135 28.1% 40.7% 5.9% 3% 22.2% 135 11.1% 34.1% 20% 23% 11.9% A-11
Table 15 What statemet best represets your viewpoit? My healthcare providers should be able to share iformatio about my health with each other without my explicit approval My explicit approval should be required before my healthcare providers share iformatio about my health with each other Percet 51 37.2 65 47.4 Not sure 21 15.3 Total 137 100 Table 16 How likely are you to use a olie service to store your medical records like those offered by Microsoft or Google? Percet Very likely 8 5.8 Somewhat likely 30 21.9 Not likely at all 43 31.4 Not sure 18 13.1 I do t kow eough about their services 38 27.7 Total 137 100 A-12
Demographics Table 17 What ethicity do you cosider yourself? Percet Hispaic or Latio 6 4.4 Not Hispaic or Latio 130 95.6 Total 136 100 Table 18 What race or races do you cosider yourself? Percet White aloe 126 92.6 Black or Africa America aloe 6 4.4 America Idia ad Alaska Native aloe - - Asia aloe - - Native Hawaiia or Pacific Islader aloe - - Some other race - - Two or more races 4 2.9 Total 136 100 Table 19 What is the highest grade or year of school you have completed? Percet Some high school 2 1.5 High school degree 17 12.4 Some college 43 31.4 Associates certificate/2 year program 10 7.3 Bachelor s degree 28 20.4 Some graduate school 10 7.3 Master s degree 17 12.4 Doctorate/Advaced degree 10 7.3 Total 137 100 A-13
Table 20 What is your geder? Percet Male 62 45.6 Female 74 54.4 Total 136 100 Table 21 What is your age? Percet 19-24 4 2.9 25-34 8 5.8 35-44 19 13.9 45-54 31 22.6 55-64 38 27.7 65-74 24 17.5 75+ 13 9.5 Total 137 100 A-14
Appedix B: Deliberative Discussio Methods ad Results B-1
Appedix B: Deliberative Discussio Methods ad Results Deliberative Discussio Upo completio of the survey, the Public Policy Ceter ivited a sub-sample of respodets from the Licol/Lacaster Couty area to participate i a deliberative discussio about electroic sharig of medical iformatio ad related topics. The format for the discussio was based about the deliberative pollig model. 1 I deliberative pollig, a survey is coducted of a radom sample of idividuals about the public policy issue(s) of iterest. That sample is the provided with educatioal materials about the issues of iterest, ad the ivited to participate i small group deliberatios about the issue ad egage a pael of experts i a questio-ad-aswer period. A followup survey of the sample is the coducted which measures the extet to which the deliberative process altered opiios or kowledge of the topic(s) of iterest. A deliberative doll thus measures chages i attitudes towards the topic(s) of iterest amog a sample of idividuals who have become more iformed about a issue. The deliberative discussio was coveed o the eveig of November 17, 2008, at the campus of the Uiversity of Nebraska-Licol. Prior to the discussio, a educatioal documet was set to all participats to review before the deliberatio. Thirty-four survey respodets atteded the deliberative discussio. The forum icluded a 1) presetatio about electroic sharig of medical iformatio by a expert from the Nebraska Departmet of Health ad Huma Services; 2) small group discussio sessios amog participats facilitated by graduate studets from the Uiversity of Nebraska- Licol Departmet of Commuicatio Studies; ad 3) a questio ad aswer sessio with a expert pael composed of members from the Nebraska ehealth Coucil, HISPC, ad the Lt. Goveror. Followig the expert pael sessio, a post-deliberative discussio survey was admiistered amog participats. All questios iitially asked o the origial survey were replicated i the post-deliberative discussio survey, ad additioal questios were also asked. 1 Deliberative Polls were first coducted i the Uited States i 1996, but have sice bee coveed i Australia, Britai, Demark, ad various other atios. More iformatio about Deliberative Pollig ca be foud at the website of the Ceter for Deliberative Democracy at Staford Uiversity (http://cdd.staford.edu/). B-2
Kowledge ad Experiece Table 22 Deliberative Discussio Results Have you ever doe ay of the followig thigs before? Used the iteret to fid iformatio about a particular illess or disease? Yes No 32 81.3% 18.8% Used email to commuicate with a healthcare professioal? 32 12.5% 87.5% Used a health isurace compay s website to lear more about your healthcare coverage or check o the status of a claim? 32 40.6% 59.4% Table 23 To the best of your kowledge, what type of medical records system does your primary healthcare provider use? Percet Pre- Post- Pre- Post- A paper record system 24 12 17.4 38.7 A computer record system 25 3 18.1 9.7 Both 69 12 50 38.7 Not sure 19 4 13.8 12.9 I do t see ay health providers 1 -.7 - Total 138 31 100 100 Table 24 Compared to the average perso, how kowledgeable do you thik you are about health iformatio security ad privacy issues? Pre- Post- Pre- Percet I kow much less tha the average perso 5-3.6 - I kow less tha the average perso 16-11.7 - Post- I kow about the same as the average perso 71 12 51.8 37.5 I kow more tha the average perso 35 18 25.5 56.3 I kow much more tha the average perso 10 2 7.3 6.3 Total 137 32 100 100 B-3
Table 25 What is your best aswer to the followig questios? Natioally, approximately how may small physicia practices curretly use electroic medical records? Percet Pre- Post- Pre- Post- Less tha 5% 20 6 14.6 18.8 Betwee 5%-35% 55 21 40.1 65.6 Betwee 36%-50% 37 5 27 15.6 Betwee 51%-75% 22-16.1 - Betwee 76%-90% 3-2.2 - Total 137 32 100 100 The federal law that covers the security ad privacy of electroic medical records is: Pre- Post- Pre- Percet Post- The Medical Iformatio Exchage Act 11 3 8.1 10 The Electroic Fraud ad Abuse Prevetio Act 8 3 5.9 10 The Patiet s Bill of Rights Act 22-16.3 - The Health Iformatio Portability ad Accoutability Act There is o federal law that covers the security ad privacy of electroic medical records 61 21 45.2 70 33 3 24.4 10 Total 135 30 100 100 B-4
Table 26 Approximately how may times have you visited the followig types of healthcare providers i the past year? No times Oce 2-3 times 4-6 times 7 or more times Primary care physicia 32 12.5% 31.3% 37.5% 18.8% 1.5% Emergecy room provider 30 80% 16.7% 3.3% - - Obstetrics or Gyecology 24 80% 13.3% 3.3% - 3.3% Nurse practitioer 27 70.4% 29.6% - - - Physicia s assistat 31 51.6% 22.6% 25.8% - - Specialist (cardiology, ocology, psychiatry, rheumatology, orthopedics, geeral surgery, etc.) 31 38.7% 32.3% 12.9% 16.1% - Other 23 82.6% 4.3% 8.7% - 4.3% Table 27 Before this survey have you see, read, or heard aythig about electroic medical records? Percet Pre- Post- Pre- Post- Yes 98 26 71 81.3 No 40 6 29 18.8 Total 138 32 100 100 Table 28 Have you ever bee formally traied or educated i some aspect of healthcare? Percet Pre- Post- Pre- Post- Yes 51 10 37.5 32.3 No 85 21 62.5 67.7 Total 136 31 100 100 B-5
Table 29 Are you curretly employed by a healthcare orgaizatio or health or life isurace compay? Percet Pre- Post- Pre- Post- Yes 19 5 13.9 16.1 No 118 26 86.1 83.9 Total 137 31 100 100 Table 30 Have you worked i ay area of healthcare i the past? Percet Pre- Post- Pre- Post- Yes 45 12 33.3 38.7 No 90 19 66.7 67.7 Total 135 31 100 100 B-6
The Role of Govermet Table 31 Below are eight geeral areas of resposibility that Nebraska s state govermet could take i regards to electroic health iformatio. Rate how importat you thik each of these areas are for the state of Nebraska, from ot importat to very importat: Not importat Somewhat importat Importat Very importat Esurig the privacy ad security of health iformatio 32 - - 15.6% 84.4% Facilitatig public-private parterships to exchage health iformatio 32 6.3% 6.3% 28.1% 59.4% Providig icetives to providers to use electroic medical records Providig iformatio to cosumers about health iformatio security ad privacy Providig grats or start-up fudig for health iformatio etworks 32 3.1% 50% 37.5% 9.4% 32-6.3% 21.9% 71.9% 32-62.5% 31.3% 6.3% Providig grats to providers to purchase electroic medical records maagemet systems 31 6.5% 48.4% 35.5% 9.7% Regulatig health iformatio etworks 32 3.1% 6.3% 37.5% 53.1% Requirig the use of electroic medical records ad health iformatio etworks 32 18.8% 18.8% 34.4% 28.1% B-7
Table 32 What should be the role of Govermet whe it comes to electroic medical records ad the electroic sharig of iformatio? Do you feel that the federal govermet has a role i ecouragig doctors to use electroic medical records? Do you feel that the federal govermet has a role i ecouragig isurace compaies to use electroic medical records? Do you feel that the Nebraska state govermet has a role i ecouragig doctors to use electroic medical records? Do you feel that the Nebraska state govermet has a role i ecouragig isurace compaies to use electroic medical records? Pre- Yes No Post- Pre- Post- Pre- Post- 135 32 45.2% 78.1% 54.8% 21.9% 134 32 41% 78.1% 59% 21.9% 134 32 51.5% 87.5% 48.5% 12.5% 133 32 48.1% 78.1% 51.9% 21.9% Table 33 Uder curret Nebraska state law, idividuals must re-authorize release of their electroic medical records to healthcare providers every 180 days. Do you thik that this 180 day period should be: Decreased to a shorter amout of time (people will have to re-authorize release of their records more frequetly) Exteded to a loger amout of time (people will have to re-authorize release of their records less frequetly) Pre- Post- Pre- Percet Post- 1 -.7-34 8 25 25 Left the same 34 6 25 18.8 Chaged to require authorizatio by idividuals aytime their electroic medical record is accessed The time limit should be removed (people could choose whe their authorizatio period expires) 16 2 11.8 6.3 21 12 15.4 37.5 Not sure 30 4 22.1 12.5 Total 136 32 100 100 B-8
Opiios of ad Cofidece i Electroic Medical Records Table 34 I your opiio, which type of medical records system do you believe best prevets improper access? Percet Pre- Post- Pre- Post- A computer record system 60 20 43.5 62.5 A paper record system 43 3 31.2 9.4 Not sure 35 9 25.4 28.1 Total 138 32 100 100 Table 35 If two doctors had exactly the same qualificatios, but oe used a electroic record system ad the other did ot, which ONE would you choose? The doctor usig a electroic record system The doctor NOT usig a electroic record system Percet Pre- Post- Pre- Post- 59 21 42.8 65.6 7-5.1 - Not sure 72 11 52.2 34.4 Total 138 32 100 100 Table 36 How cofidet are you that whe you go to see a healthcare professioal, he or she has a accurate ad complete picture of your ecessary medical iformatio ad prior medical history? Percet Pre- Post- Pre- Post- Very cofidet 38 8 27.7 25 Somewhat cofidet 68 17 49.6 53.1 Not very cofidet 18 5 13.1 15.2 Not at all cofidet 8 2 5.8 6.1 Not sure 5-3.6 - Total 137 32 100 100 B-9
Table 37 The followig is a list of potetial beefits of electroic medical records. Which ONE is the most importat potetial beefit to you? Pre- Post- Pre- Percet Post- Better treatmet i a emergecy 26 6 18.8 18.8 Icreased efficiecy i healthcare resultig i decreased costs A icrease i the ability of healthcare providers to share ad review the same patiet records ad work together to deliver better care 15 1 10.9 3.1 70 21 50.7 65.6 Reductio i medical errors 10 3 7.2 9.4 Persoal access to ad cotrol of my ow health record 12 1 8.7 3.1 Noe of these 2-1.4 - Not sure 3-2.2 - Total 138 32 100 100 Table 38 The followig is a list of potetial problems with electroic medical records. Which ONE do you thik creates the greatest problem? A iteret or commuicatio outage makes my records uavailable A hacker bypasses security ad steals my persoal data My healthcare providers lear about my health iformatio whe it is ot ecessary for them to kow it My health isurace compay lears about my health iformatio whe it is ot ecessary for them to kow it My employer lears about my health iformatio whe it is ot ecessary for them to kow it Pre- Post- Pre- Percet Post- 45 16 32.6 50 48 8 34.8 25 6-4.3-17 3 12.3 9.4 11 3 8 9.4 Noe of these 5 2 3.6 3 Not sure 6-4.3 - Total 138 32 100 100 B-10
Table 39 How strogly do you agree or disagree with each of the followig statemets? The use of electroic medical records ca decrease medical errors. The use of electroic medical records ca reduce healthcare costs. The use of electroic medical records makes it easier to esure patiets privacy. The use of electroic medical records ca improve the quality of care patiets receive by reducig patiet wait times ad errors i documetatio. The use of electroic medical records ca lower my healthcare costs by reducig uecessary tests ad procedures. If doctors ad researchers were able to share iformatio more easily via electroic medical systems; patiets could receive better care based o curret scietific kowledge. Patiets should have access to their ow electroic medical record maitaied by their physicia. Patiets should have access to their ow electroic medical record through a orgaizatio ot liked with their providers. Medical offices should provide patiets with the ability to schedule appoitmets via email or o the iteret. Patiets should be able to email their doctors as part of their overall care. The beefits of electroic medical records outweigh the risks. Doctors should be compesated for time spet coectig with patiets by phoe or electroic systems. Agree strogly Agree somewhat Disagree somewhat Disagree strogly Not sure 32 62.5% 31.3% 6.3% - - 31 48.4% 45.2% - - 6.5% 32 12.5% 68.8% 15.6% - 3.1% 32 75% 18.8% 6.3% - - 32 65.6% 31.3% 3.1% - - 32 81.3% 18.8% - - - 32 75% 21.9% 3.1% - - 32 15.6% 21.9% 25% 15.6% 21.9% 32 25% 53.1% - 12.5% 9.4% 32 21.9% 50% 12.5% 3.1% 12.5% 32 59.4% 40.6% - - - 32 15.6% 50% 18.8% 9.4% 6.3% B-11
Table 40 My healthcare providers should be able to share iformatio about my health with each other without my explicit approval My explicit approval should be required before my healthcare providers share iformatio about my health with each other What statemet best represets your viewpoit? Pre- Post- Pre- Percet Post- 51 19 37.2 59.4 65 10 47.4 31.3 Not sure 21 3 15.3 9.4 Total 137 32 100 100 Table 41 How likely are you to use a olie service to store your medical records like those offered by Microsoft or Google? Percet Pre- Post- Pre- Post- Very likely 8 1 5.8 3.1 Somewhat likely 30 7 21.9 21.9 Not likely at all 43 15 31.4 46.9 Not sure 18 2 13.1 6.3 I do t kow eough about their services 38 7 27.7 21.9 Total 137 32 100 100 B-12
Demographics Table 42 What ethicity do you cosider yourself to be? Percet Pre- Post- Pre- Post- Hispaic or Latio 6 1 4.4 3.1 Not Hispaic or Latio 130 31 95.6 96.9 Total 136 32 100 100 Table 43 What race or races do you cosider yourself to be? Percet Pre- Post- Pre- Post- White aloe 126 31 92.6 96.9 Black or Africa America aloe 6 1 4.4 3.1 America Idia ad Alaska Native aloe - - - - Asia aloe - - - - Native Hawaiia or Pacific Islader aloe - - - - Some other race - - - - Two or more races 4-2.9 - Total 136 32 100 100 B-13
Table 44 What is the highest grade or year of school you have completed? Percet Pre- Post- Pre- Post- Some high school 2-1.5 - High school degree 17-12.4 - Some college 43 11 31.4 34.4 Associates certificate/2 year program 10 6 7.3 18.8 Bachelor s degree 28 4 20.4 12.5 Some graduate school 10 2 7.3 6.3 Master s degree 17 4 12.4 12.5 Doctorate/Advaced degree 10 5 7.3 15.2 Total 137 32 100 100 Table 45 What is your geder? Percet Pre- Post- Pre- Post- Male 62 15 45.6 46.9 Female 74 17 54.4 53.1 Total 136 32 100 100 B-14
Table 46 What is your age rage? Percet Pre- Post- Pre- Post- 19-24 4-2.9-25-34 8-5.8-35-44 19 3 13.9 9.7 45-54 31 6 22.6 19.4 55-64 38 10 27.7 32.3 65-74 24 6 17.5 19.4 75+ 13 6 9.5 19.4 Total 137 31 100 100 B-15
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The Uiversity o Nebraska does ot discrimiate based o geder, age, disability, race, color, religio, marital status, vetera s status, atioal or ethic origi, or sexual orietatio.