Electronic Medical Records and Public Perceptions: A Deliberative Process

Electronic Medical Records and Public Perceptions: A Deliberative Process

Tarik Abdel-Monem (University of Nebraska Public Policy Center, Lincoln, NE, USA), Mitchel N. Herian (University of Nebraska Public Policy Center, Lincoln, NE, USA) and Nancy Shank (University of Nebraska Public Policy Center, Lincoln, NE, USA)
DOI: 10.4018/jhisi.2013070103
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Abstract

Public attitudes about electronic medical records (EMRs) have been primarily gauged by one-time opinion polls. The authors investigated the impact of an interactive deliberative polling process on general attitudes towards EMRs and perceptions of governmental roles in the area. An initial online survey was conducted about EMRs among a sample of respondents (n = 138), and then surveyed a sub-sample after they had engaged in a deliberative discussion about EMR issues with peers and policymakers (n = 24). Significant changes in opinions about EMRs and governmental roles were found following the deliberative discussion. Overall support for EMRs increased significantly, although concerns about security and confidentiality remained. This indicates that one way to address concerns about EMRs is to provide opportunities for deliberation with policymakers. The policy and theoretical implications of these findings are briefly discussed within.
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Public Views On Electronic Medical Records

There are conflicting definitions for what constitutes an EMR (National Alliance for Health Information Technology, 2008). For purposes of using consistent terminology that would be familiar to the public, we used the term EMR to mean patient-centered medical information that can be shared electronically between hospitals, clinics, physician offices, or other healthcare delivery locations.2 A basic EMR includes a patient’s history and demographics, patient problem list, physician clinical notes, comprehensive list of patient’s medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically (Hsiao, Socey, & Cai 2011). The use of EMRs has been increasing in recent years (Wright, 2012). In 2011, 57% of office-based physicians reported that they use all or partial EMR systems: a 12% increase from 2010 (U.S. Department of Health and Human Services, National Center for Health Statistics, 2011). Hospital adoption of EHRs systems has doubled since 2009 to 34.8% (Charles, Furukawa, & Hufstader, 2012) although only a small percentage report having comprehensive electronic records systems (Jha et al., 2009).

Federal and State governments are playing a large role in coordinating or directing initiatives to increase adoption of EMRs. Prior to governmental interventions starting at the turn of the 21st century, adoption of electronic medical records was low with less than 20 percent of physicians using any type of EMR (Gans et al., 2005; Hsiao et al., 2010). Federal efforts have included making direct grants for EMR implementation and research, supporting nationwide standards and software certification, and loosening legal restrictions against hospital-to-physician technology sharing (Accelerating the Adoption of Health Information Technology, 2006). The 2009 American Recovery and Reinvestment Act created financial incentives for physician adoption of EMRs, funding to support State-led interoperability, outreach centers to assist physicians and hospitals to adopt EMRs, eventual financial penalties for physicians and healthcare organization that have not adopted electronic medical records, and strengthened security and privacy laws (American Recovery and Reinvestment Act, 2009). The 2010 Patient Protection and Affordable Care Act amends the Health Insurance Portability and Accountability Act by requiring the Secretary of Health and Human Services to adopt a set of operating rules for electronic transactions with the goal of “creating as much uniformity in the implementation of the electronic standards as possible” (Patient Protection and Affordable Care Act, 2010). As of February 2012, the $3.1 billion in federal incentive payments have been disbursed to hospitals and doctors who have adopted EMRs (U.S. Department of Health and Human Services, 2012).

State governments also have become active in promoting the electronic exchange of patient data. From January 2007 to August 2008, more than 370 bills were introduced in State Legislatures with provisions relating to health information technology involving planning, protecting privacy, financing, promoting the exchange of health information, and driving adoption and use (National Conference of State Legislatures, 2009). States have played vital roles spurring EMR initiatives that have facilitated collaboration between public and private stakeholders in the health information technology field (DesRoches & Jha, 2009).

Consumer input in healthcare services is not a new phenomenon. Consumers are regularly asked to evaluate individual-level services for specific treatment episodes and patient satisfaction (Davies & Ware, 1988; Fan, Burman, McDonell, & Fihn, 2005; Stubbe, Brouwer, & Delnoij, 2007; Wright, Craig, Campbell, Schaefer, & Humble, 2006). Less frequent but growing trends include consumer participation in systems-wide service or delivery decision-making (Crawford et al., 2002; Thornicroft & Tansella, 2005; van de Bovenkamp, Trappenburg, & Grit, 2009), and involving community members in public health research (Lantz, Viruell-Fuentes, Israel, Softley, & Guzman, 2001; Minkler, 2005; Rhodes, Hergenrather, Wilkin, Alegría-Ortega, & Montaño, 2006).

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