Trends in Consumer Access and Use of Electronic Health Information

In ONC Data Brief 30, trends in consumer access and use of electronic health information are examined. Over the past few years, a number of policy changes have been put in place to increase individuals' access to their personal electronic health information. HIPAA was modified to clarify that if an individual's health information is available electronically, individuals have a right to obtain that information electronically. In Stage 2 Meaningful Use, CMS requires eligible providers and hospitals participating in the Medicare and Medicaid EHR Incentive Program to use certified EHR technology with the capability for patients to electronically view, download and transmit (VDT) their health information electronically. From 2011 to 2014, participation in the Blue Button Initiative, a public-private partnership to increase consumer access and use of their health data grew from 30 organizations to more than 650. This brief provides national estimates of consumers' access and use of their electronic health information based upon nationally representative surveys conducted from 2012 to 2014.

The data reveal 9 major trends:

1.       Individuals' electronic access to their medical records increased significantly in 2014. In 2014, nearly 4 in 10 Americans were offered electronic access to their medical record. The proportion of Americans offered online access to their medical records rose by more than a third between 2013 and 2014.

2.      In 2014, over half of individuals who were offered access viewed their record at least once within the last year. About one-third of individuals accessed their medical record one to two times in 2014 whereas about one-fifth of individuals accessed their online record once or twice in 2013. In both 2013 and 2014, about one in ten individuals accessed their online medical record more than 6 times over a one-year period.

3.      Almost all individuals report having access to laboratory results within their online medical record. Among individuals using online medical records, more than 90% report having laboratory test results in their record. Among individuals who have used an online medical record, almost 8 in 10 report having a list of health and medical problems in their online medical record. Approximately three-quarters of individuals report having access to a current list of medications within their online medical record.

4.      Individuals most commonly use online medical records for monitoring health. In both 2013 and 2014, about seven in ten individuals who accessed their online medical record, used it to monitor their health. Approximately one-third of individuals downloaded information from their online medical record in 2014; rates of downloading were similar in 2013. Rates of sharing information with at least one other individual or party decreased between 2013 and 2014; however, these decreases were not significant. In both 2013 and 2014, about one in ten individuals used their online medical records to correct medical records. In both 2013 and 2014 about one in ten individuals used their online medical records to transmit their data to somewhere else, such as a PHR or app.

5.      In 2014, 8 in 10 individuals who accessed their medical record online considered the information useful. In 2014, fewer than 5% of individuals who had used an online medical record within the last year considered it 'not useful.' Between 2013 and 2014, there was a significant increase in the proportion of individuals who were neutral about the usefulness of their online medical record. The proportion of individuals who considered their online medical records as 'not useful' and as 'useful' significantly declined between 2013 and 2014.

6.      Lack of need remains the top reason for not accessing an online medical record. In both 2013 and 2014, about three-quarters of individuals who did not access their online medical record indicated they didn't access it because that they did not have a need to use it. About one in ten individuals who did not access their online medical record indicated it was because they had more than one online record. Although not a statistically significant difference, fewer individuals noted privacy or security concerns in 2014 as a reason for not accessing their online medical record compared to 2013.

7.      Over one-quarter of individuals either didn't believe they had a right or were unaware of their right to an electronic copy of their medical record. Almost three-quarters of individuals of individuals were aware of their right to access their medical record electronically. Individuals who were aware of their right to access their medical record electronically were offered online access to their medical record by their health insurer or health care provider at significantly higher rates compared to individuals who were not aware or did not believe they had a right to an electronic copy of their medical record were offered online access.

8.     In 2014, almost one-in-five individuals whose health care provider had an EHR requested their health care provider electronically exchange their medical record. Over two-thirds of individuals report their health care provider has an EHR. Across all individuals nationwide, regardless of whether their provider has an EHR or not, over one-in-ten individuals (12%) requested their health care provider electronically send their medical record to another health care provider.

9.      Among individuals who visited a health care provider within the past year, over one-third experienced at least one gap in information exchange in 2014. Although there was a decline in the proportion of individuals who experienced at least one gap in information exchange between 2012 and 2014, these do not represent significant changes. Having to recount one's medical history because the health care provider did not receive records from another health care provider is consistently the most common gap in information exchange experienced by individuals between 2012 and 2014. Other common gaps in information exchange that remain issues in 2014 relate to test results; this includes having to bring test results with you to an appointment (15%) and having to wait for test results longer than you thought reasonable (11%).

In short, there is a significant opportunity for consumer outreach to increase individuals' awareness regarding electronic access and use of online medical records. Individuals' who were aware of their right to a copy of their electronic medical record had significantly higher rates of being offered online access compared to those who were unaware or incorrectly believed they didn't have this right. A lack of need remains the most frequently cited reason for not accessing an online medical record. Illustrating the value of using an online medical record to manage one's health and address information gaps among providers could increase usage among those individuals who cited a lack of need as a reason for not accessing an online medical record.

What do you make of the results? Has your organization promoted electronic access and use of online medical records by patients? Do you think there are any potential problems with allowing patients open online access? Let us know in the comments below.

Disparities in Individuals' Access and Use of Health Information Technology

ONC Data Brief 34, published last month, examined the disparities in individuals’ access and use of health information technology in 2014. Findings from nationally representative surveys show that individuals' use of information technology (IT) for health needs increased significantly between 2013 and 2014. Prior analysis revealed that disparities in online access of medical records and use of IT for health-related needs existed by certain socio-demographic characteristics and geographic settings in 2013.

The data reveal 5 major trends:

1.       Individuals whose provider had an EHR were offered online access to their medical record at three times the rate of those whose provider does not. In 2014, individuals whose provider had an EHR had significantly higher rates of using IT for health needs compared to individuals whose provider did not have an EHR. The percent of individuals offered access to online medical records, emailing providers, and looking up test results online increased between 2013 and 2014; however, the rate of increase was greater among those whose provider had an EHR.

2.      Individuals with lower incomes and less education had significantly lower rates of being offered online access to their health information. While about half of individuals with incomes of $100,000 or more were offered online access to their health information, only about one-quarter of individuals with less than a $25,000 annual income were offered online access. Individuals with more than a four year college degree were offered online access at about twice the rate as individuals who had a high school degree or less.

3.      Individuals who had difficulty speaking English were offered online access to their medical records at significantly lower rates. While 39% of individuals who spoke English very well or well were offered online access to their medical record, only 15% of individuals who didn't speak English well and only 5% of those who didn't speak English at all were offered online access to their medical record. Almost twice as many white, non-Hispanic individuals were offered online access to their medical record as compared to Hispanic individuals.

4.      Among individuals offered online access to their medical record, those with higher incomes and more education were more likely to view their record. Individuals with annual incomes of at least $50,000 had significantly higher rates of viewing their online medical record compared to individuals with incomes less than $25,000. While almost two-thirds of individuals with annual incomes higher than $100,000 viewed their online medical record at least once within the past year, only about one-third of individuals with incomes less than $25,000 viewed their record within the past year. Individuals with a high school degree or less had significantly lower rates of viewing their online medical record compared to individuals with more than a four-year college degree. Individuals with a four-year college degree or more education were over twice as likely to view their online medical record compared to those without a high school degree.

5.      Individuals with more education and higher income use certain types of IT for health-related needs at significantly higher rates. Individuals 50-59 years of age had significantly higher rates of text-messaging and emailing their provider, looking up online test results, and using a mobile health application compared to individuals 70 years or older. Individuals with no disabilities had significantly higher rates of emailing their provider and using a mobile health application than individuals with a disability. Individuals residing in rural areas have significantly lower rates of emailing their provider, looking up test results online and using a smart phone health application compared to individuals residing in suburban settings.

What do you make of the results? Do your experiences with patients reflect the data above? Let us know in the comments below.

Health Groups Aim to Make Medical Records Easier to Access

On February 29, the Obama administration announced that technology companies, hospital systems and doctors' groups have agreed to take steps to make electronic health records easier for consumers to access and use.

While most care facilities have adopted digital practices, the systems used are often insular and do not transmit information to each other, limiting their usefulness to patient. The latest initiative is meant to speed removal of technological bottlenecks. It is unclear how immediately impactful the initiative will be, as President Obama leaves office in less than a year.

To date, $27 billion in government subsidies have been distributed to encourage the adoption of electronic medical records by hospitals and doctors’ offices. But the results so far have fallen short of the data-driven transformation that proponents envisioned. With new personal health applications for mobile devices hitting the market, there is a renewed push to clear obstacles rooted in different technologies and clashing competitive priorities among vendors and health care providers.

The agreement announced by the Obama administration covers 16 health care technology companies, which all-together represent approximately 90% of hospital electronic records used nationally. But, the announcement also lacked a hard timetable.

The 16 companies have pledged to:

1.       Improve consumer access. Theoretically, patients would be able to easily access their records from one provider and transfer them to another. That second provider would be able to seamlessly import the earlier records into its system.

2.     Stop blocking health information sharing. A 2015 ONC report found that some health care organizations were blocking the sharing of information outside their group.

3.      Put standards for secure efficient digital communications into effect, which would allow different systems to more easily transmit information with each other.

Joining the technology companies are major hospital systems such as Hospital Corporation of America and Tenet Healthcare, as well as insurers like Kaiser Permanente. The American Medical Association, the American Society of Clinical Oncology and other medical groups are also participating.

The original article can be found at the following address: http://nyti.ms/1Qp4Q1w

Trends in Consumer Concerns Regarding Privacy and Security of Health Records

The ONC’s newest data brief examines trends in individuals’ perceptions regarding privacy and security of medical records and exchange of health information. Using data from a nationwide survey administered from 2012-2014, the ONC now summarizes the trends in consumers’ attitudes toward privacy and security concerns and preferences regarding electronic health records (EHR) and health information exchange (HIE).

The data reveal 6 major trends:

1.       Individuals' concerns about the privacy and security of both paper and electronic medical records declined significantly between 2013 and 2014 from 75% very or somewhat concerned to 58% very or somewhat concerned. This is a statistically significant difference (p < .05).

2.      In 2014, a similar number of individuals - about one in five - expressed lack of concern about both the privacy and the security of their medical records. The proportion of individuals who were "very concerned" about the privacy of their medical records decreased by about fifteen percentage points between 2013 and 2014. This is a statistically significant difference (p < 0.05).

3.      Individuals' concerns regarding the privacy and security of their medical record do not significantly differ by whether they have an electronic versus paper medical record. There were no statistically significant differences between paper versus electronic health records.

4.      Between 2012 and 2014, at least three-quarters of individuals supported their health care providers' use of EHRs despite any potential privacy or security concerns.

5.      Individuals' concerns regarding unauthorized viewing of medical records when sent by fax or electronic means declined significantly between 2013 and 2014. Between 2013 and 2014, concerns regarding having medical records sent by fax declined by 20% and concerns regarding medical records sent by electronic means declined by 16%. This is a statistically significant difference (p < 0.05).

6.      Between 2012 and 2014, at least 7 in 10 individuals have supported electronically exchanging their health records despite potential privacy or security concerns. There are no significant differences between years (p < 0.05).

In summary, as EHR adoption and HIE increased among hospitals and physicians, consumers' concerns regarding HIE and the privacy and security of medical records declined. However, it is important to note that these perceptions reflect individuals' points of view prior to announcement in 2015 of several large health care information breaches. Additionally, it is unclear as to whether the significant decreases in concerns between 2013 and 2014 are an anomaly or whether this represents the beginning of a trend towards decreasing privacy and security concerns.

What do you make of the results? Has your organization faced any consumer concerns over using one medical record-keeping format over another? Let us know in the comments below.