title: The role of health care experience and consumer information efficacy in shaping privacy and security perceptions of medical records: national consumer survey results.
abstract: BACKGROUND
  Providers' adoption of electronic health records (EHRs) is increasing and consumers have expressed concerns about the potential effects of EHRs on privacy and security. Yet, we lack a comprehensive understanding regarding factors that affect individuals' perceptions regarding the privacy and security of their medical information.
  
  
  OBJECTIVE
  The aim of this study was to describe national perceptions regarding the privacy and security of medical records and identify a comprehensive set of factors associated with these perceptions.
  
  
  METHODS
  Using a nationally representative 2011-2012 survey, we reported on adults' perceptions regarding privacy and security of medical records and sharing of health information between providers, and whether adults withheld information from a health care provider due to privacy or security concerns. We used multivariable models to examine the association between these outcomes and sociodemographic characteristics, health and health care experience, information efficacy, and technology-related variables.
  
  
  RESULTS
  Approximately one-quarter of American adults (weighted n=235,217,323; unweighted n=3959) indicated they were very confident (n=989) and approximately half indicated they were somewhat confident (n=1597) in the privacy of their medical records; we found similar results regarding adults' confidence in the security of medical records (very confident: n=828; somewhat confident: n=1742). In all, 12.33% (520/3904) withheld information from a health care provider and 59.06% (2100/3459) expressed concerns about the security of both faxed and electronic health information. Adjusting for other characteristics, adults who reported higher quality of care had significantly greater confidence in the privacy and security of their medical records and were less likely to withhold information from their health care provider due to privacy or security concerns. Adults with higher information efficacy had significantly greater confidence in the privacy and security of medical records and less concern about sharing of health information by both fax and electronic means. Individuals' perceptions of whether their providers use an EHR was not associated with any privacy or security outcomes.
  
  
  CONCLUSIONS
  Although most adults are confident in the privacy and security of their medical records, many express concerns regarding sharing of information between providers; a minority report withholding information from their providers due to privacy and security concerns. Whether individuals thought their provider was using an EHR was not associated with negative privacy/security perceptions or withholding, suggesting the transition to EHRs is not associated with negative perceptions regarding the privacy and security of medical information. However, monitoring to see how this evolves will be important. Given that positive health care experiences and higher information efficacy were associated with more favorable perceptions of privacy and security, efforts should continue to encourage providers to secure medical records, provide patients with a "meaningful choice" in how their data are shared, and enable individuals to access information they need to manage their care.
authors.affiliation: U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, Washington, DC, United States. vaishali.patel@hhs.gov.
authors.forename: Vaishali
authors.identifier: http://orcid.org/0000-0002-1175-4428
authors.initials: V
authors.lastname: Patel
authors.forename: Ellen
authors.identifier: http://orcid.org/0000-0002-5291-2998
authors.initials: E
authors.lastname: Beckjord
authors.forename: Richard P
authors.identifier: http://orcid.org/0000-0001-6884-0653
authors.initials: RP
authors.lastname: Moser
authors.forename: Penelope
authors.identifier: http://orcid.org/0000-0001-9671-6705
authors.initials: P
authors.lastname: Hughes
authors.forename: Bradford W
authors.identifier: http://orcid.org/0000-0003-1142-1161
authors.initials: BW
authors.lastname: Hesse
keywords: attitudes; electronic health records; health information exchange; health knowledge; health surveys; practice; privacy confidentiality
references.citation: J Am Med Inform Assoc. 2014 Mar-Apr;21(2):374-8
references.pmid: 23975624
references.citation: J Health Commun. 2004 Sep-Oct;9(5):443-60; discussion 81-4
references.pmid: 15513791
references.citation: J Am Med Inform Assoc. 2013 Jan 1;20(1):152-6
references.pmid: 22847306
references.citation: Inform Health Soc Care. 2011 Dec;36(4):233-52
references.pmid: 21851182
references.citation: Mod Healthc. 2012 May 28;42(22):10
references.pmid: 22741489
references.citation: Health Aff (Millwood). 2013 Feb;32(2):376-84
references.pmid: 23381531
references.citation: Health Serv Res. 2011 Jun;46(3):920-38
references.pmid: 21275986
references.citation: J Health Commun. 2010;15 Suppl 2:146-58
references.pmid: 20845200
references.citation: Health Commun. 2008;23 (1):70-9
references.pmid: 18443994
references.citation: Mod Healthc. 2012 Oct 15;42(42):14
references.pmid: 23163087
references.citation: J Health Commun. 2012;17(8):979-89
references.pmid: 23020763
references.citation: Disabil Rehabil. 2012;34(15):1277-83
references.pmid: 22324423
references.citation: J Med Internet Res. 2010 Dec 18;12(4):e73
references.pmid: 21169163
references.citation: Am J Manag Care. 2011 Dec;17 (12 Spec No.):SP111-6
references.pmid: 22216769
references.citation: Health Aff (Millwood). 2013 Aug;32(8):1470-7
references.pmid: 23840050
references.citation: Health Aff (Millwood). 2012 Mar;31(3):527-36
references.pmid: 22392663
references.citation: N Engl J Med. 2010 Aug 5;363(6):501-4
references.pmid: 20647183