Consumers Are Ready to Accept the Transition to Online and Electronic Records If They Can Be Assured of the Security Measures

Prajesh Chhanabhai, BSc, MSc, HINZ, ACM NZ Chapter; Alec Holt BSc, DipSci, MCom (Otago), MNZRS, PhD (Otago)

Disclosures
In This Article

The Health Consumer

Traditionally the healthcare consumer has been the "least consumer-like" and the least informed.[11] Protection from social stigma as well as the belief that patients would get sicker once they knew their medical condition were the reasons used by many traditional physicians to discourage the use of EHRs. With expanding populations and the increase in occurrences of epidemics, medicine has become more scientific, and thus medical knowledge has started to become available to the layperson.[11] In the last 20 years, the emphasis has changed from cure of health conditions to prevention, with an emphasis on health and wellness.[12] According to Amatayakul,[11] "Patients have become interested in making choices for themselves about their physicians, treatments and lifestyles"; this can be clearly observed in the change of terminology from medical care to healthcare. The term medical care focuses primarily on processes administered by a physician, whereas healthcare encompasses a broader range of services and procedures.[13]

The emergence of communication technologies and the incentives in the health sector to include consumers in their operations are some of the factors in increasing the importance of the consumer in the healthcare setting.[13] Another element that has influenced the move toward a consumer-based approach has been the change in the way patients pay for their health services. From the earliest times, when health services were bartered like a normal commodity through the respective healers, patients became even less like consumers, as the payment for their health services was done by third parties in the form of medical aid companies.[11] When the third parties became a key player in the health sector, patients lost consumer identity totally, as they did not directly purchase healthcare services. However, with the shift toward managed healthcare and health plans, patients had to pay more to get additional choices.[11] Thus, they ceased being just patients, and have shifted toward the role of consumer, as they demanded more information about their healthcare providers, diseases, and treatments.

The biggest factor in cementing the role of the patient as a consumer is through the growth and the innovative capabilities of technology. The increasing availability of interactive information has enabled many services to be available online. Health information is now only a click away, with many Internet users visiting Web sites that contain health information and treatment options. The growth of discussion boards and bulletin boards has allowed individuals to share their experiences of specific diseases and treatments. This has introduced another dimension to the healthcare industry in which consumers are more knowledgeable and understanding of the terminology and procedures that are used in the health sector.

According to Eysenbach,[14] initially the technology had been looking at development and growth through the eyes of the medical professional, with the drive toward consumerism. This has changed and has seen the birth of consumer health informatics. Consumer health informatics is defined by Eysenbach[14] as "the branch of medical informatics that analyses consumers' needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers' preferences into medical information systems." This definition agrees with Amatayakul's[11] statement that the "principle of consumer health informatics is that of empowering individuals to play a greater role in their own healthcare and to be active participants in the decisions that affect their healthcare" Figure 1 shows how consumer health informatics has shifted from individuals just having a choice to being empowered. Essentially, all health information can now be used to benefit the consumer of healthcare.

Figure 1.

The shift from an individual having a choice to being empowered. Adapted from Amatayakul.[11]

Empowerment will only occur if consumers themselves are allowed to interact with the healthcare system. This interaction would be one in which consumers do not receive just limited feedback, but one that promotes multiway feedback. This idea has been adopted by the European Union, who realized that the greatest interaction would occur if patients had access to their records.[14] In October 1998 the European Union required that each of their member countries pass legislation to ensure that consumers in those countries had access to all their health records.[14] With governments recognizing the need for patients to become key stakeholders of their own health, now is the perfect time for the push toward the implementation of the EHR. The implementation of EHRs is thus not a case of "if it will happen"; rather it is a question of "how long until it is completed?" President George Bush announced that he wanted most Americans to have an EHR by 2014, and he has allocated a budget of $100 million to ensure that this does happen.[15] The United Kingdom has set aside ₤2.3 billion to ensure that 50 million patient records are digitized by 2010.[16]

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