title: Trust, confidentiality, and the acceptability of sharing HIV-related patient data: lessons learned from a mixed methods study about Health Information Exchanges.
abstract: BACKGROUND
  Concerns about the confidentiality of personal health information have been identified as a potential obstacle to implementation of Health Information Exchanges (HIEs). Considering the stigma and confidentiality issues historically associated with human immunodeficiency virus (HIV) disease, we examine how trust-in technology, processes, and people-influenced the acceptability of data sharing among stakeholders prior to implementation of six HIEs intended to improve HIV care in parts of the United States. Our analyses identify the kinds of concerns expressed by stakeholders about electronic data sharing and focus on the factors that ultimately facilitated acceptability of the new exchanges.
  
  
  METHODS
  We conducted 549 surveys with patients and 66 semi-structured interviews with providers and other stakeholders prior to implementation of the HIEs to assess concerns about confidentiality in the electronic sharing of patient data. The patient quantitative data were analyzed using SAS 9.2 to yield sample descriptive statistics. The analysis of the qualitative interviews with providers and other stakeholders followed an open-coding process, and convergent and divergent perspectives emerging from those data were examined within and across the HIEs.
  
  
  RESULTS
  We found widespread acceptability for electronic sharing of HIV-related patient data through HIEs. This acceptability appeared to be driven by growing comfort with information technologies, confidence in the security protocols utilized to protect data, trust in the providers and institutions who use the technologies, belief in the benefits to the patients, and awareness that electronic exchange represents an enhancement of data sharing already taking place by other means. HIE acceptability depended both on preexisting trust among patients, providers, and institutions and on building consensus and trust in the HIEs as part of preparation for implementation. The process of HIE development also resulted in forging shared vision among institutions.
  
  
  CONCLUSIONS
  Patients and providers are willing to accept the electronic sharing of HIV patient data to improve care for a disease historically seen as highly stigmatized. Acceptability depends on the effort expended to understand and address potential concerns related to data sharing and confidentiality, and on the trust established among stakeholders in terms of the nature of the systems and how they will be used.
authors.affiliation: Center for AIDS Prevention Studies, AIDS Policy Research Center, University of California, 50 Beale St, suite 1300, San Francisco, CA 94105, USA. andres.maiorana@ucsf.edu
authors.forename: Andre
authors.initials: A
authors.lastname: Maiorana
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Steward
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Koester
authors.forename: Charles
authors.initials: C
authors.lastname: Pearson
authors.forename: Starley B
authors.initials: SB
authors.lastname: Shade
authors.forename: Deepalika
authors.initials: D
authors.lastname: Chakravarty
authors.forename: Janet J
authors.initials: JJ
authors.lastname: Myers
mesh_terms: D003219:Confidentiality; D003299:Cooperative Behavior; D003625:Data Collection / Q000379:methods*; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections; D006801:Humans; D033181:Information Dissemination; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D036301:Qualitative Research; D035502:Trust; D014481:United States