Abstract
National adoption of Electronic Health Records (EHRs) is considered an essential component of the health care system overhaul sought by policy makers and health care professionals, in both U.S. and Europe, to cut costs and increase benefits. And yet, along with the technological aspects, the human factor consistently proves to be a critical component to diffusion of any IT system, and is even more so regarding health care. The highly personal and sensitive nature of health care data and the associated concerns about privacy impede even the most efficient and technologically perfect system. Our objective is to investigate individuals’ attitudes towards EHR and what factors form these attitudes. If we understand individuals’ attitudes regarding EHR and the factors that influence them, we will be in a better position to take responsive measure to facilitate Privacy by Design for EHRs. A positivist research model is empirically tested using survey data from U.S. and Italy and structural equation modeling techniques. We find that perceived effectiveness of regulatory mechanisms positively impact trust; perceived effectiveness of technological mechanisms positively impacts perceived privacy control and trust; the latter two help reduce privacy concerns which, along with perceived benefits, convenience, and Internet experience, play the privacy calculus-type formation of attitudes towards EHR.
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Appendices
Appendix 1: Survey Instrument. All Items Were Measured on 5-Point Lickert Scale, Lowest “Completely Disagree” to Highest—“Completely Agree” Unless Specified Otherwise
Item (Indicate to what extent you agree with the following:) | ||
|---|---|---|
Construct | Code | Bold items were used in the model test |
Attitude toward EHR ATT | att1 | I believe it is a good idea to have electronic health records |
att2 | I believe that electronic health records is a good thing to do | |
att3 | I have a favorable opinion about electronic health records | |
Convenience CO | co1 | My own online medical record would help me get all my doctors on the same page when they treat me |
co2 | I’d like to have all my health information in one place—and get to it with the click of a mouse | |
co3 | I can access my bank account online. Why not my medical records? | |
co4 | I’ve often felt the health care system has all the power. Having my own online health record seems to even it out a little bit | |
co5 | I’m tired of playing ‘telephone tag’ with doctors and filling out the same forms. Why can’t I do some of this stuff online? |
Item (Indicate to what extent you agree with the following:) | ||
|---|---|---|
Construct | Code | Bold items were used in the model test |
Perceived privacy control CTRL | ctrl1 | I think I will have control over what personal information is released by the electronic health records systems |
ctrl2 | I believe I will have control over who can get access to my personal information collected by the electronic health records systems | |
ctrl3 | I believe I will have control over how personal information is used by the electronic health records systems | |
ctrl4 | In general, I believe I will be able to control my personal information provided to health care | |
ctrl5 | I believe I will have control over the amount of my personal information collected by the electronic health records systems | |
Satisfaction with current health care LIKE | like1 | I like our current health care system |
like2 | I believe the current health care system is good enough | |
Privacy concerns—collection PCONC | pconc1 | It usually bothers me when health care entities ask me for personal information. |
pconc2 | When health care entities ask me for personal information, I sometimes think twice before providing it | |
pconc3 | It bothers me to give personal information to so many health care entities | |
pconc4 | I’m concerned that health care entities are collecting too much personal information about me | |
Privacy concerns—errors PCONE | pcone1 | All the personal information in computer database should be double-checked for accuracy—no matter how much this costs |
pcone2 | Health care entities should take more steps to make sure that the personal information in their files is accurate | |
pcone3 | Health care entities should have better procedures to correct errors in personal information | |
pcone4 | Health care entities should devote more time and effort to verifying the accuracy of the personal information in their databases | |
Privacy concerns—unauthorized access PCONUA | pconua1 | Health care entities should devote more time and effort to preventing unauthorized access to personal information |
pconua2 | Computer databases that contain personal information should be protected from unauthorized access no matter how much it costs | |
pconua3 | Health care entities should take more steps to make sure that unauthorized people cannot access personal information in their computers |
Item (Indicate to what extent you agree with the following:) | ||
|---|---|---|
Construct | Code | Bold items were used in the model test |
Privacy concerns—secondary use PCONSU | pconsu1 | Health care entities should not use personal information for any purpose unless it has been authorized by the individuals who provided the information |
pconsu2 | When people give personal information to a company for some reason, the company should never use the information for any other reason | |
pconsu3 | Health care entities should never sell the personal information in their computer databases to other health care entities | |
pconsu4 | Health care entities should never share personal information with other health care entities unless it has been authorized by the patient who provided the information | |
Perceived benefits PERBEN | perben1 | I believe that it is beneficial for me to have my health records electronically |
perben2 | I believe electronic health records will improve health care | |
perben3 | Electronic health records will generate positive results for the health care in our society | |
Perceived effectiveness of regulatory mechanisms REGUL | regul1 | I believe that the law is effective in protecting me from misuse of my personal electronic health care data |
regul2 | I believe that the law effectively governs the practice of how my electronic health care records are collected, used, and protected | |
regul3 | I believe that the current regulations are able to address violations in usage of my electronic health care records | |
Perceived effectiveness of technological mechanisms TECHN | techn1 | I think that the electronic health records will use effective technologies |
techn2 | I think that the electronic health records will use reliable technologies | |
techn3 | I think that there are a lot of good technologies that will help the electronic health records | |
Trust | trust1 | I think that electronic health records are dependable |
trust2 | I think that electronic health records are trustworthy | |
trust3 | I trust that electronic health records provide good service | |
Health status HS | hs | In general, would you say your health is (Poor—Excellent) |
Experience with internet EXP | How frequently did you use the Internet for the following activities (Never-Always) | |
exp1 | Shopped or purchased something | |
exp2 | Made travel arrangements or bought an airline ticket | |
exp3 | Paid bills or managed financial accounts |
Appendix 2: Structural Model for U.S. and Italy
Notes: Path coefficients’ statistical significance: *p < .05; **p < .01, NS not significant, bold arrow significant path, dashed arrow insignificant path
Notes: Path coefficients’ statistical significance: *p < .05; **p < .01, NS not significant; bold arrow significant path, dashed arrow—insignificant path
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Dinev, T., Albano, V., Xu, H., D’Atri, A., Hart, P. (2016). Individuals’ Attitudes Towards Electronic Health Records: A Privacy Calculus Perspective. In: Gupta, A., Patel, V., Greenes, R. (eds) Advances in Healthcare Informatics and Analytics. Annals of Information Systems, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-23294-2_2
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