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

Results

The demographic findings showed that the majority of people who took part in this survey were between the ages of 20 and 39. The results indicated that those attending healthcare providers were in their early 20s or reaching middle age. The participant group was also made up of more women than men. This agreed with the findings of the Australian Institute of Health Welfare and Cancer study.[21] They found that women tended to visit a healthcare provider more than men.[21] In this study, 200 women made up the overall figure of 300. This is 66% of the population sample.

The survey was sent to the 4 main city centers in New Zealand. The highest proportion of the population sample came from Dunedin. The percentage breakdown from each location is also shown in Table 2 . In addition to the city breakdown, Table 3 gives a summary of the numbers according to their placement on either the North or South Island. Table 3 shows that the survey sample obtained an even distribution across the North and South islands.

It was found that a high percentage of the sample were regular computer users (82%), used email (80%), and used the Internet (70%); however, the results of the survey indicated that a large proportion (44%) of the sample population did not undertake online purchasing. Those who did purchase items over the Internet were also mainly in the seldom-use category (5%), which may suggest that these participants only used a computer when they wanted to buy something online.

Participants were asked about their concerns in regard to the confidentiality and privacy of their health records ( Table 4 ). The findings indicated that generally participants were concerned about their health information.

Participants were asked their opinion in regard to the privacy and confidentiality of their medical records as well as their knowledge about the NHI number. Although 95% of the population had an NHI number, this study found that only 31.7% of the sample indicated that they knew about the NHI number. This may be a general indication that a majority of the New Zealand health-seeking population are unaware of the NHI number and the information that it stores.

Participants were given a list of potential problems that may be encountered by EHRs. The results showed that most participants perceived that the EHR would lead to their medical information being shared easily. They believed that EHRs would lead to sensitive medical information leaking out (40.3%) as well as allowing the sharing of their medical information without their knowledge (42%). The participants did not believe too strongly in the statement "electronic health records could increase medical errors," with only a small difference between those who agreed with it (41%) and those who did not (38%). This could indicate that the perception in regard to medical errors is not the major concern that the health consumer has with EHRs. The next 2 statements highlighted this fact. Participants believed that access was an issue with EHRs. These results do concur with that perception. Overall 53% of the people surveyed believed that EHRs would have an inherent weakness in its security system, whereas 29% thought that the EHRs would have a strong security system built in.

Having been given a list of potential problems, participants were then given a list of problems that affect other electronic systems. Participants were asked to rank how strongly they agreed that each of these problems would be transferred to the EHR domain. The 2 main problems included vendor access to the system and the actions of hackers and crackers who might harm the system deliberately. When grouped into the categories of agree, neutral, and disagree, Figure 2 demonstrates the perception that all of the problems given will affect EHRs as well.

Figure 2.

Graph illustrating participants' perceptions of problems that affect other electronic systems, and how they will affect electronic health records.

Figure 2 indicates that 72.7% of participants believed that vendor access would be a real problem with EHRs, whereas 79.4% were worried about hackers. This fits in with the strong concern with regard to access that was found by the earlier question. Malicious software (68%) was also a concern by the participants. On the other hand, only 56% and 53.6% believed that long-term accessibility and failure to back up would be a problem, indicating that the primary concern is with unregulated access to the system.

When informed about the various security mechanisms that might be implemented with EHRs, the results pointed out that if implemented then participants believed that EHRs would be more secure.

Table 5 shows that there is a strong sentiment that with the addition of antivirus software, firewalls, restricted system access, audit trails, and encryption, EHRs would be more secure. In each case, over 80% of the respondents agreed that the security mechanism would make the EHR more secure.

The final quantitative question asked whether participants believed that EHRs were more secure than paper-based records. It was hypothesized that participants would believe that paper records are still more secure. Initially it was also thought that there would be a large difference between the 2 answers in favor of paper records; however, the results from this study indicated otherwise. The difference between those who believed that EHRs were more secure than paper records and those who believed that paper records were more secure is only 9.8%. Over half (54.9% [163]) of the participants answered that they believed that paper records were a more secure system. The most common reason given was that "I don't trust computers as they tend to crash," which was followed up by a more security-relevant comment: "I am scared of hackers." Hackers were mentioned 100 times in the comments section; this makes up 61% of the total number of people who believed that paper records are safer. This is a clear indication that participants believe that the security is still not strong enough to prevent hack attacks; 45.1% (134) of the people surveyed agreed that EHRs are a more secure method of storing health records. The most common comment pertained to the fact that "papers get lost, damaged, and misplaced," which has been described as one of the reasons to move to an electronic system.

Chi square and Fisher's exact test were carried out on all the questions with the dependent variables being participants' concern for the privacy and security of their medical condition, and the participants' answer to whether EHRs are safer than paper records. The following research questions were found to be statistically significant; in each case P < .05:

  • Younger age groups have less security concerns, as they have a greater understanding of computers (P = .02).

  • Women are more concerned about the security of health information on EHRs, as they are greater users of healthcare (P = .006).

  • There is an identifiable common trend across the country. The perceptions of consumers in regard to the security of EHRs between the North Island and the South Island did not show any significant differences (P = .023).

  • Those who buy items over the Internet are less apprehensive about security concerns (P = .01).

  • Many people in New Zealand have not heard about EHRs, and this influences their feelings about them (P = .004).

  • The benefits are all consumer-focused; thus consumers agreed that EHRs will provide most of the benefits that have been proposed (P = .04).

  • Consumers, when given a list of the negative aspects of the EHR, will agree that the EHR may raise a number of concerns for them (P = .03).

  • When consumers are made aware of the security measures that may be in place, they believe that their record is more secure (P = .001).

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