title: Sharing medical data for health research: the early personal health record experience.
abstract: BACKGROUND
  Engaging consumers in sharing information from personally controlled health records (PCHRs) for health research may promote goals of improving care and advancing public health consistent with the federal Health Information Technology for Economic and Clinical Health (HITECH) Act. Understanding consumer willingness to share data is critical to advancing this model.
  
  
  OBJECTIVE
  The objective was to characterize consumer willingness to share PCHR data for health research and the conditions and contexts bearing on willingness to share.
  
  
  METHODS
  A mixed method approach integrating survey and narrative data was used. Survey data were collected about attitudes toward sharing PCHR information for health research from early adopters (n = 151) of a live PCHR populated with medical records and self-reported behavioral and social data. Data were analyzed using descriptive statistics and logistic regression to characterize willingness, conditions for sharing, and variations by sociodemographic factors. Narrative data were collected through semistructured focus group and one-on-one interviews with a separate sample of community members (n = 30) following exposure to PCHR demonstrations. Two independent analysts coded narrative data for major and minor themes using a shared rubric of a priori defined codes and an iterative inductive process. Findings were triangulated with survey results to identify patterns.
  
  
  RESULTS
  Of PHCR users, 138 out of 151 (91%) were willing to share medical information for health research with 89 (59%) favoring an opt-in sharing model. Willingness to share was conditioned by anonymity, research use, engagement with a trusted intermediary, transparency around PCHR access and use, and payment. Consumer-determined restrictions on content and timing of sharing may be prerequisites to sharing. Select differences in support for sharing under different conditions were observed across social groups. No gender differences were observed; however differences in age, role, and self-rated health were found. For example, students were more likely than nonstudents to favor an opt-out sharing default (unadjusted odds ratio [OR] = 2.89, 95% confidence interval [CI] 1.10 - 7.62, P = .03). Participants over age 50 were less likely than younger participants to report that payment would increase willingness to share (unadjusted OR = 0.94, 95% CI 0.91 - 0.96, P < .001). Students were more likely than nonstudents to report that payment would increase their willingness to share (unadjusted OR 9.62, 95% CI 3.44 - 26.87, P < .001). Experiencing a public health emergency may increase willingness to share especially among persons over 50 (unadjusted OR 1.03, 95% CI 1.01 - 1.05, P = .02); however, students were less likely than non-students to report this attitude (unadjusted OR 0.13, 95% CI 0.05 - 0.36, P < .001). Finally, subjects with fair or poor self-rated health were less likely than those with good to excellent self-rated health to report that willingness to share would increase during a public health emergency (unadjusted OR 0.61, 95% CI 0.38 - 0.97, P = .04).
  
  
  CONCLUSIONS
  Strong support for sharing of PCHR information for health research existed among early adopters and focus group participants, with support varying by social group under different conditions and contexts. Allowing users to select their preferred conditions for sharing may be vital to supporting sharing and fostering trust as may be development of safety monitoring mechanisms.
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, United States. elissa.weitzman@childrens.harvard.edu
authors.forename: Elissa R
authors.initials: ER
authors.lastname: Weitzman
authors.forename: Liljana
authors.initials: L
authors.lastname: Kaci
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandl
mesh_terms: D000368:Aged; D000533:Altruism; D003142:Communication; D003219:Confidentiality; D004196:Disease Outbreaks / Q000145:classification / Q000517:prevention & control; D004522:Educational Status; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D055991:Health Records, Personal; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009511:New England; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011446:Prospective Studies