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)

In This Article


Survey Design

As part of a nationwide survey on the perceptions of the security of EHRs, 300 participants took part in this study. The sample population was health consumers visiting small- to medium-sized healthcare practices; hence the consumers targeted would be in the process of either receiving healthcare or accompanying someone who was undergoing treatment. These people would be more concerned and aware of their health information than the public generally.

Participants were obtained through a 2-step process. The first step involved locating practices and obtaining consent to allow their practice to be used as a survey point. This was achieved by going through the phone book and identifying a number of practices in the major city centers (Auckland, Christchurch, Dunedin, and Wellington). A letter was sent to each chosen practice outlining the study and asking them to participate. The letters were standardized. Each had a reply form printed on blue paper to enable easier communication with the practice manager or doctor. A total of 70 letters were sent out. The letter outlined that the time required by the practice would be minimal, as participants would fill out the survey as they waited to be seen by the doctor. The practices sent in their replies in a prepaid envelope. Step 2 involved those practices that replied in the affirmative. This step involved preparing the survey packs. Each pack was made up of an information sheet, consent form, and a 2-page questionnaire. Each practice received a minimum of 30 survey packs. The packs were sent out with a postage-paid return envelope and a request to the practice managers or doctors to return the surveys as soon as all the surveys had been completed.

The survey was designed iteratively over a period of 3 months. During that time, the survey was narrowed down to target the specific area that was being studied, with the rules outlined by Leedy and Ormrod.[20] Questions used in previous studies[3,9,10] were modified and used in this study. Questions from the previous studies were used, as they had a few questions that targeted the number of specific areas that were relevant to this study. The primary focus of these other studies was not just security, and a number of these questions were adapted and used in this questionnaire to strengthen the results from the survey. Furthermore, other questions were developed with the help of the statistics department and others involved in the health informatics field. Feedback was obtained from both the NZHIS and the Royal New Zealand College of General Practitioners (RNZCGP), and their recommendations and suggestions were included in the survey. When changes were complete, the survey underwent a pilot test. The pilot test was conducted to ensure that the responses obtained from the survey would be sufficient to answer the research question(s). The pilot also tested the language used in the survey, to ensure that there was no ambiguous terminology. The pilot study was conducted over 2 days. Twenty students from a university hall of residence participated. Participants came from a wide range of backgrounds, ages, and across both sexes. The pilot study identified a number of questions that needed to be changed to allow for better understanding, as well as several format changes. The responses to the pilot study were also an indication of the type of answers that the main survey would get. Changes were then made, and the revised survey was tested on a small group of participants. This survey was found to be easy to understand, and it was subsequently employed to obtain the data required for this study. When the survey had been finalized, ethics approval was sought and obtained from the University of Otago Human Ethics Committee, Dunedin, New Zealand.

Statistical Analysis

The survey included demographic questions that enabled us to determine whether there were any relationships that would be clearly attributed to demographic qualities, including, age, sex, and location. Ethnicity was not added because of the time constraint. Location was seen as important, as the study took place in the 2 major cities of the North and South Islands, respectively. This would indicate whether there was any major difference between the 2 islands.

Data were initially analyzed with standardized descriptive statistics. Further analysis to identify any statistically significant results was undertaken with chi-square analysis or Fisher's exact test (as appropriate). The dependent variables in each case were the participants' concern for the privacy and security of their medical information and the participants' answers to whether they believed that EHRs were more secure than paper-based records. All analyses were computed in SPSS version 13.0, and 2-tailed significance was considered at the P < .05 level.


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