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Health Information Exchange (HIE), as an important element of the Health Information Technology (HIT) arrangement, is intended to facilitate electronic movement of patients’ medical information among healthcare organizations during the treatment process (Vest & Gamm, 2010). HIE helps healthcare providers access the most recent and complete health information about their patients (Simon, Evans, Benjamin, Delano, & Bates, 2009). Therefore, HIE underlines a number of potential benefits such as improving quality, safety and efficacy of healthcare delivery (Dimitropoulos & Rizk, 2009). The Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009 in the U.S. to provide financial support for the widespread adoption of HIT and nationwide use of HIE (Adler-Milstein, DesRoches, & Jha, 2011). As HIE plays an important role in the healthcare reform (Ancker, Edwards, Miller, & Kaushal, 2012), this technology has been expected to rise exponentially over the current decade in United States (Adler-Milstein, Bates, & Jha, 2009). However, despite its advantages, the HIE system has not seen rapid adoption in the healthcare industry as a preferred mode of exchange.
There are several stakeholders in the exchange process that affect HIE success and one of the most important parties is health consumers or patients. The role of consumers is vital since their consent is considered as an important requirement to render information exchange. The extensive adoption of HIE is subject to patients’ engagement and the means that policy makers need to use to win their trust (Tripathi, Delano, Lund, & Rudolph, 2009). The patients’ attitude towards sharing their personal health information can influence the design of future health information systems (Whiddett, Hunter, Engelbrecht, & Handy, 2006). Thus, in order to gain the potential benefits associated with HIE, patient support will be essential (Patel et al., 2012). However, very little research has studied attitudes of patients towards exchange process (Dhopeshwarkar, Kern, O’Donnell, Edwards, & Kaushal, 2012).
Patel et al. (2012) report that patient support for HIE is a function of two key variables: potential benefits related to HIE as well as privacy and security concerns. Although some studies have attempted to identify expected benefits and risks of HIE, it is still not clear what benefits can convince patients to support HIE implementation and what concerns can prevent them from supporting electronic exchange of medical information among healthcare providers (Park et al., 2013). Literature has discussed that there are some potential benefits associated with HIE such as: better care coordination, reduced number of medical tests, and improved quality of care (Dimitropoulos & Rizk, 2009). Nevertheless, current literature does not clarify how well patients recognize the benefits of HIE compared to the other exchange methods (Simon et al., 2009). To earn all the expected benefits of HIE, patients’ endorsement is a key challenge that is not well studied and addressed (Or & Karsh, 2009; Sicotte & Paré, 2010). On the other hand, several studies have argued that privacy and security issues are important barriers to patient participation in HIE (Wen, Kreps, Zhu, & Miller, 2010). Nonetheless, Whiddett et al. (2006) mention that little work has studied patients’ perspectives on privacy concerns stemming from the exchange of health data among several care providers and most of current publications on HIE privacy issues, whether studied clinicians’ views or highlighted legal issues. Consistent with the current literature, the perceived value from HIE is not well studied from consumers’ perspectives and it is not very clear how patients would trade off the perceived benefits and concerns related to HIE implementation. Furthermore, the focus of existing literature has been on certain types of patients who deal with very sensitive medical information (e.g.: patients with HIV) (Teixeira, Gordon, Camhi, & Bakken, 2011) and the perspectives of ordinary patients have not fully discussed.