Public Attitudes about Health Information Technology, and Its Relationship to Health Care Quality, Costs, and Privacy

The United States spends more on health care than any other country and has one of the fastest growth rates in health spending among developed countries (Organization for Economic Co-Operation and Development 2008). Yet the United States performs below other countries on measures such as life expectancy, access to care, and demographic disparities (Kaiser Family Foundation 2007). There is also evidence that preventable errors lead to high costs and poor health care outcomes in the United States (Kohn, Corrigan, and Donaldson 2000; Fernandopulle et al. 2003; Zhan and Miller 2003; Encinosa and Hellinger 2008; Kumar and Steinebach 2008;). The Institute of Medicine has identified the use of health information technology (health IT) as a measure to help improve health care system performance and quality of care (Committee on Quality of Health Care in America, Institute of Medicine 2001). The health care system still operates primarily with paper-based records and lags behind many other industries in adoption of IT (Hillestad et al. 2005; Robert Wood Johnson Foundation 2006; Blumenthal and Glaser 2007; Shields et al. 2007; DesRoches et al. 2008; Furukawa et al. 2008; Jha et al. 2009;). In 2004, President Bush set a goal of assuring that most Americans have electronic medical records (EMRs) within the next 10 years, and he announced several new initiatives, including doubling funding for demonstration projects on health IT, using the federal government to foster the adoption of health IT, and creating the position of National Coordinator for Health Information Technology (George W. Bush White House Archives 2004; Office of the National Coordinator 2008). More recently, President Obama set the goal of achieving EMRs for all Americans within 5 years (Childs, Chang, and Grayson 2009) and set aside more than U.S.$20 billion (Congressional Budget Office 2009) in direct and indirect supports for health IT adoption as part of the American Recovery and Reconstruction Act of 2009 (U.S. Congress 2009). Although health IT has been demonstrated to improve medical care under certain conditions, there is no consensus on how to achieve these benefits across the U.S. health care system as a whole (Chaudhry et al. 2006; Blumenthal and Glaser 2007;). Existing research on the slow adoption rate of health IT notes the high cost of adoption; technological change leading to system obsolescence, accreditation, and standardization issues; concerns about integration with administration systems; providers' productivity during implementation; identifying systems that meet organizational needs; and privacy and security concerns (Valdes et al. 2004; Hillestad et al. 2005; Robert Wood Johnson Foundation 2006; Shields et al. 2007; DesRoches et al. 2008; Furukawa et al. 2008; Blumenthal 2009; Jha et al. 2009;). Most research has examined clinicians' and health care organizations' decisions and attitudes about health IT. There are only a handful of studies on consumer attitudes about health IT despite substantial evidence that consumer attitudes toward a technology are a very important factor in its adoption and success (Venkatesh 2000). An environmental scan to identify surveys on consumers' use and opinions on electronic health records (EHRs) and personal health record (PHRs) found few that were rigorous, noting that response rates and question development methods were generally unreported (Donelan and Miralles 2008). Previous studies of consumers' perceptions of health IT studies have generally shown the public to be relatively unknowledgeable of health IT, but they have also yielded contradictory results. In a 2006 study, only 4 percent of respondents had doctors who used any form of health IT and less than one-third of Americans had heard of the federal government's efforts to create a nationwide system of EMRs (Harris Poll 2007). This study showed strong public support for the entire range of currently available health IT, and a 2006 survey showed that Americans overwhelmingly want to have electronic copies of their medical records. However, another study conducted at the same time found that only 34 percent of respondents believed that an EMR would improve the quality of health care they receive; some 24 percent did not believe an EMR would help improve quality; and 42 percent were undecided or needed more information (Robeznieks 2006). Most recently, a study conducted among members of a large, staff model managed care organization making use of health IT shows that patients agree that health IT can improve the efficiency of care delivery (Chen et al. 2009). Prior surveys also reveal important consumer concerns over the potential exposure of their private medical information (Connecting for Health 2003; Harris Poll 2007;). While some studies show that the majority of consumers trust in hospitals', public health agencies', and providers' treatment of their privacy (Harris Poll 2005), these studies indicated that the public is wary of the ability of the institutions to manage their personal data (Goodwin et al. 2002). A 2006 web survey found that individuals believe the expected benefits of EMRs to patients and society were offset by the risks to privacy (Harris Poll 2007). Although useful, prior studies on consumer attitudes toward health IT have important limitations. First, most of these studies are 3–6 years old, and given the rapid developments in this field, the public's awareness of and attitudes toward health IT are likely to be changing rapidly as well. In addition, as noted above, these studies focused on a small group of specific questions or were conducted with a very select group of respondents (e.g., closed panels of members from a single health plan). Finally, these studies used web panels, omnibus surveys, and polls with relatively small sample sizes, with the accompanying methodological problems such as nonrandom sampling, biased selection, and nonresponse bias, and limited statistical power. These methodological limitations are a possible explanation for the studies' often contradictory results. In this paper, we present findings from a very recent, comprehensive, and methodologically rigorous survey of public attitudes toward health IT and EMRs in particular. The current study uses a large sample size (1,015), is based on probability-based random-digit-dial (RDD) sampling, was conducted using a stand-alone interview (and not a larger omnibus survey on many topics), and with rigorous callback rules and in-depth interviewer training, unlike many polls. While these approaches do not eliminate all potential sources of bias (e.g., from nonresponse), they do ensure that this study provides timely and rigorous results that are generalizable to the U.S. general population. We also explore a number of topics that have not been previously investigated.