Politics and Public Perception of EMRs A division between benefits and security

by David Orenstein free-lance writer

The public, well aware of HIPAA, has rising confidence that personal medical information is kept private, but the vast majority of Americans have no inkling of the national campaign to ensure the widespread adoption of electronic medical records. When confronted with the prospect of EMRs, the public seems to be split on whether they are a good idea.

These are the main results of a major survey of consumer attitudes about technology and health information privacy. Professor Alan Westin of Columbia University and the Center for Social and Legal Research commissioned the Harris Interactive poll of 1012 people and presented it Feb 23 at a committee hearing of the US Department of Health and Human Services.

The hearing was quite timely. Professor Westin’s testimony occurred less than a week after a scare in south Florida jolted a lot of people out of any complacency they had on the issue. A statistician in the Palm Beach County health department mistakenly emailed to 800 department employees a list of the 6500 county residents who have HIV or AIDS. The statistician quickly realized the error and had IT workers purge the files, but the goof-up received national press attention and alarmed some local activists.

Such dramatic incidents are rare, but they make the gravity of the issue clearer than any expert testimony in Washington could. Accidental disclosures or intentional disclosures of sensitive health information are real threats. Perhaps this explains why consumers can feel comforted by how HIPAA tangibly codifies their privacy, yet still feel unnerved by electronic medical records. Their comfort is fragile and must be rebuilt every time a new technology arrives for storing and spreading information.

Regarding specific quantifications of this confidence and concern that Mr Westin found, of the survey respondents, 23 percent said HIPAA increased their confidence “a great deal” that medical information was handled properly. Another 44 percent reported that their confidence had been boosted “somewhat.” Only 18 percent said that HIPAA had not boosted their confidence at all.

Although 67 percent had received a HIPAA privacy notice, few people had heard much about EMRs. The survey found that 71 percent of respondents never had heard of the national push to establish an EMR system.

Just because the public is not aware doesn’t mean that it isn’t wary. The survey explicitly laid out for respondents both the major benefits and privacy concerns regarding EMRs. The responses clearly revealed an apprehension among the public that even strong confidence from HIPAA could not overcome.

For example, the survey script said the goal of EMRs is “to improve the effectiveness of patient care, lessen medical errors, and reduce the high costs of paper handling.” But when the survey then presented some plausible privacy concerns, a majority was either very or somewhat concerned about all of them. Information leaks concerned 70 percent of respondents; increased information sharing without patient knowledge concerned 69 percent. The potential of computerization to increase medical errors concerned 65 percent of the survey pool. Disturbing for physicians is that 65 percent expressed concern that EMRs might make people less willing to share information with healthcare providers.

In all, 48 percent said they felt the benefits of EMRs will outweigh the risks, but 47 percent felt the opposite way. The poll’s margin of error was 3 percent. Anyone who considers EMRs as the wave of the future must acknowledge that although HIPAA has laid some good groundwork, the industry still has work to do to sell the idea to a nervous public.

The author of this monthly column, David Orenstein, is a technology and business writer in Silicon Valley. To learn more about a technology topic in Computing Care, email him at davealli@comcast.net.