Privacy vs usability: a qualitative exploration of patients' experiences with secure Internet communication with their general practitioner.
BACKGROUND
Direct electronic communication between patients and physicians has the potential to empower patients and improve health care services. Communication by regular email is, however, considered a security threat in many countries and is not recommended. Systems which offer secure communication have now emerged. Unlike regular email, secure systems require that users authenticate themselves. However, the authentication steps per se may become barriers that reduce use.


OBJECTIVE
The objective was to study the experiences of patients who were using a secure electronic communication system. The focus of the study was the users' privacy versus the usability of the system.


METHODS
Qualitative interviews were conducted with 15 patients who used a secure communication system (MedAxess) to exchange personal health information with their primary care physician.


RESULTS
Six main themes were identified from the interviews: (1) supporting simple questions, (2) security issues, (3) aspects of written communication, (4) trust in the physician, (5) simplicity of MedAxess, and (6) trouble using the system. By using the system, about half of the patients (8/15) experienced easier access to their physician, with whom they tended to solve minor health problems and elaborate on more complex illness experiences. Two thirds of the respondents (10/15) found that their physician quickly responded to their MedAxess requests. As a result of the security barriers, the users felt that the system was secure. However, due to the same barriers, the patients considered the log-in procedure cumbersome, which had considerable negative impact on the actual use of the system.


CONCLUSIONS
Despite a perceived need for secure electronic patient-physician communication systems, security barriers may diminish their overall usefulness. A dual approach is necessary to improve this situation: patients need to be better informed about security issues, and, at the same time, their experiences of using secure systems must be studied and used to improve user interfaces.
Norwegian Research Centre for Electronic Patient Records (NSEP), Norwegian University of Science and Technology, N-7489 Trondheim, Norway. akselht@svt.ntnu.no
Aksel
A
Tjora
Trung
T
Tran
Arild
A
Faxvaag
D003142:Communication; D016494:Computer Security; D003219:Confidentiality; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D007407:Interviews as Topic; D009664:Norway; D010361:Patients; D010821:Physicians, Family