Introduction
Health information sharing between patients and their heath care providers may improve diagnoses, increase patient education and promote self-care [1], [2]. Analyses of de-identified healthcare utilization data have proven useful to assess patterns of care, therapy effectiveness and safety. The use of electronic medical records (EMRs) as the primary source of patient medical information is still relatively rare, but increasing in Canadian, British and American primary care. In addition to improved legibility, the organized note structure of many EMRs supports high quality patient summaries desirable for shared clinical care. Similarly the detailed healthcare information in EMRs makes them important sources of information for clinical, research and policy questions [3], [4], [5]. The same characteristics seen as the strengths of electronic medical record databases are also sources of health information privacy concerns [6], [7]. These include: organization of complex information in standard database format, rapidly accessible key fields such as diagnoses, medications and diagnostics in legible format and compact storage of multiple patient's data. Paper health records have information security concerns, but these may be under-appreciated compared to computerized records.
Health information privacy (HIP) and security have been reported to be prominent concerns of the public, patients and providers [8], [9], [10], [11]. In several studies, patients and physicians have expressed their desire to limit medical-record access among healthcare workers in order to reduce the potential for misuse [10], [12], [13]. In another study, patients were concerned about the secondary use of their health information for research purposes unless all personal identifiers were removed or consent is obtained [14]. However, these studies were somewhat theoretical in that patients and physicians had limited exposure to electronic medical record practices.
Studies evaluating electronic health information communication and storage systems in Europe have noted that exposure to both electronic medical records and to the exchange of personal health information among health care providers through a secure electronic system increased patient confidence in such technologies [15], [16]. This may suggest that patients actively counterbalance their privacy concerns with their perceived benefits from EMR and may be reassured as time passes.
There are limited data on HIP concerns of patients and physicians within North American electronic healthcare settings. Studies by our group have shown that few patients expressed concerns when their paper health records were transferred to electronic medical records, then abstracted for research [17]. In addition a minority of patients that were part of electronic medical record practices in north-central Pennsylvania expressed general concerns in security and confidentiality of their online medical information [18]. Despite such findings, the current clinical and research environment requires a more specific investigation of patient's and physician's opinions.
Our objectives in this study were to: (a) explore the opinions of EMR-using physicians and their patients regarding the benefits and risks of electronic medical records and electronic health information sharing within and outside the family practice, (b) identify predictive demographic variables, (c) investigate the change in opinions over the course of a computerized decision support system intervention linked to EMRs.