title: Patient Perspectives on Sharing Anonymized Personal Health Data Using a Digital System for Dynamic Consent and Research Feedback: A Qualitative Study.
abstract: BACKGROUND
  Electronic health records are widely acknowledged to provide an important opportunity to anonymize patient-level health care data and collate across populations to support research. Nonetheless, in the wake of public and policy concerns about security and inappropriate use of data, conventional approaches toward data governance may no longer be sufficient to respect and protect individual privacy. One proposed solution to improve transparency and public trust is known as Dynamic Consent, which uses information technology to facilitate a more explicit and accessible opportunity to opt out. In this case, patients can tailor preferences about whom they share their data with and can change their preferences reliably at any time. Furthermore, electronic systems provide opportunities for informing patients about data recipients and the results of research to which their data have contributed.
  
  
  OBJECTIVE
  To explore patient perspectives on the use of anonymized health care data for research purposes. To evaluate patient perceptions of a Dynamic Consent model and electronic system to enable and implement ongoing communication and collaboration between patients and researchers.
  
  
  METHODS
  A total of 26 qualitative interviews and three focus groups were conducted that included a video presentation explaining the reuse of anonymized electronic patient records for research. Slides and tablet devices were used to introduce the Dynamic Consent system for discussion. A total of 35 patients with chronic rheumatic disease with varying levels of illness and social deprivation were recruited from a rheumatology outpatient clinic; 5 participants were recruited from a patient and public involvement health research network.
  
  
  RESULTS
  Patients were supportive of sharing their anonymized electronic patient record for research, but noted a lack of transparency and awareness around the use of data, making it difficult to secure public trust. While there were general concerns about detrimental consequences of data falling into the wrong hands, such as insurance companies, 39 out of 40 (98%) participants generally considered that the altruistic benefits of sharing health care data outweighed the risks. Views were mostly positive about the use of an electronic interface to enable greater control over consent choices, although some patients were happy to share their data without further engagement. Participants were particularly enthusiastic about the system as a means of enabling feedback regarding data recipients and associated research results, noting that this would improve trust and public engagement in research. This underlines the importance of patient and public involvement and engagement throughout the research process, including the reuse of anonymized health care data for research. More than half of patients found the touch screen interface easy to use, although a significant minority, especially those with limited access to technology, expressed some trepidation and felt they may need support to use the system.
  
  
  CONCLUSIONS
  Patients from a range of socioeconomic backgrounds viewed a digital system for Dynamic Consent positively, in particular, feedback about data recipients and research results. Implementation of a digital Dynamic Consent system would require careful interface design and would need to be located within a robust data infrastructure; it has the potential to improve trust and engagement in electronic medical record research.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom.
authors.forename: Karen
authors.identifier: http://orcid.org/0000-0003-2038-2600
authors.initials: K
authors.lastname: Spencer
authors.forename: Caroline
authors.identifier: http://orcid.org/0000-0002-0539-928X
authors.initials: C
authors.lastname: Sanders
authors.forename: Edgar A
authors.identifier: http://orcid.org/0000-0003-1779-0814
authors.initials: EA
authors.lastname: Whitley
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-0862-5737
authors.initials: D
authors.lastname: Lund
authors.forename: Jane
authors.identifier: http://orcid.org/0000-0002-7311-4725
authors.initials: J
authors.lastname: Kaye
authors.forename: William Gregory
authors.identifier: http://orcid.org/0000-0001-5881-4857
authors.initials: WG
authors.lastname: Dixon
mesh_terms: D000328:Adult; D000368:Aged; D003219:Confidentiality; D003299:Cooperative Behavior; D000068240:Data Anonymization; D057286:Electronic Health Records; D005246:Feedback; D005260:Female; D017144:Focus Groups; D006801:Humans; D033181:Information Dissemination; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012941:Social Responsibility; D035502:Trust; D055815:Young Adult
keywords: consent; data sharing; eHealth; public trust