Consumers are ready to accept the transition to online and electronic records if they can be assured of the security measures.
BACKGROUND
Healthcare has entered the electronic domain. This domain has improved data collection and storage abilities while allowing almost instantaneous access and results to data queries. Furthermore, it allows direct communication between healthcare providers and health consumers. The development of privacy, confidentiality, and security principles are necessary to protect consumers' interests against inappropriate access. Studies have shown that the health consumer is the important stakeholder in this process. With the international push toward electronic health records (EHRs), this article presents the importance of secure EHR systems from the public's perspective.


OBJECTIVE
To examine the public's perception of the security of electronic systems and report on how their perceptions can shape the building of stronger systems.


METHODS
A cross-sectional survey (September-November 2005) of people attending healthcare providers (n = 400) was conducted in the 4 major cities in New Zealand. Participants were surveyed on computer use, knowledge of EHR-proposed benefits and issues, security issues, and demographics.


RESULTS
A total of 300 surveys were completed and returned (a 75% response rate), with 180 (60%) being women. One hundred eighty-eight (62.6%) had not heard of EHRs, with those who had heard of them indicating that they were a positive innovation in the health sector. However, 202 (73.3%) participants were highly concerned about the security and privacy of their health records. This feeling was further accentuated when participants were asked about security of electronic systems. Participants were worried about hackers (79.4%), vendor access (72.7%), and malicious software (68%). Participants were also introduced to various security systems, and in each case, over 80% of participants believed that these would make EHR systems more secure. A number of chi-square tests were carried out with each variable, and it was found that there were strong relationships between age, location, computer use, EHR knowledge, and the concern for privacy and the security of medical records (P < .05). The survey also showed that there was a very small difference (9.8%) between health consumers who believed that paper records are more secure than EHRs and those who believed otherwise.


CONCLUSIONS
The findings showed that for the EHR to be fully integrating in the health sector, there are 2 main issues that need to be addressed: The security of the EHR system has to be of the highest level, and needs to be constantly monitored and updated. The involvement of the health consumer in the ownership and maintenance of their health record needs to be more proactive. The EHR aims to collect information to allow for "cradle to the grave" treatment; thus, the health consumer has to be seen as a major player in ensuring that this can happen correctly. The results from this study indicated that the consumer is ready to accept the transition, as long as one can be assured of the security of the system.
Chhanabhai
Prajesh
P
Department of Information Science, University of Otago, Dunedin, New Zealand. pchhanabhai@infoscience.otago.ac.nz
Holt
Alec
A
D000328:Adult; D016494:Computer Security / Q000592:standards; D003219:Confidentiality / Q000592:standards; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D006801:Humans; D008499:Medical Records / Q000592:standards; D016347:Medical Records Systems, Computerized / Q000592:standards; D010865:Pilot Projects; D012637:Security Measures / Q000592:standards