title: The double-edged sword of electronic health records: implications for patient disclosure.
abstract: OBJECTIVE
  Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients' global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure.
  
  
  METHODS
  A nationally representative sample from the 2012 Health Information National Trends Survey was analyzed using bivariate and multivariable logit regressions to examine whether global ratings of care suppress the relationship between EHR provider-use and patient non-disclosure.
  
  
  RESULTS
  13% of respondents reported having ever withheld information from a provider because of privacy/security concerns. Bivariate analysis showed that withholding information was unrelated to whether respondents' providers used an EHR. Multivariable analysis showed that accounting for respondents' global ratings of care revealed a positive relationship between having a provider who uses an EHR and withholding information.
  
  
  CONCLUSIONS
  After accounting for global ratings of care, findings suggest that patients may non-disclose to providers to protect against the perceived EHR privacy and security risks. Despite evidence that EHRs inhibit patient disclosure, their advantages for promoting quality of care may outweigh the drawbacks.
  
  
  CONCLUSIONS
  Clinicians should leverage the EHR's value in quality of care and discuss patients' privacy concerns during clinic visits, while policy makers should consider how to address the real and perceived privacy and security risks of EHRs.
authors: Department of Sociology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.
authors: Celeste
authors: C
authors: Campos-Castillo
authors: Department of Sociology, Institute for Security, Technology, and Society, Dartmouth College, Hanover, New Hampshire, USA.
authors: Denise L
authors: DL
authors: Anthony
mesh_terms: D016494:Computer Security; D003219:Confidentiality; D030881:Disclosure; D057286:Electronic Health Records; D019538:Health Care Surveys; D006801:Humans; D015999:Multivariate Analysis; D011787:Quality of Health Care; D014481:United States
keywords: consumer surveys; electronic health records; patient-doctor communication; privacy; quality of care