title: Trust Me, I'm a Doctor: Examining Changes in How Privacy Concerns Affect Patient Withholding Behavior.
abstract: As electronic health records (EHRs) become ubiquitous in the health care industry, privacy breaches are increasing and being made public. These breaches may make consumers wary of the technology, undermining its potential to improve care coordination and research.
  
  
  
  Given the developing concerns around privacy of personal health information stored in digital format, it is important for providers to understand how views on privacy and security may be associated with patient disclosure of health information. This study aimed to understand how privacy concerns may be shifting patient behavior.
  
  
  
  Using a pooled cross-section of data from the 2011 and 2014 cycles of the Health Information and National Trends Survey (HINTS), we tested whether privacy and security concerns, as well as quality perceptions, are associated with the likelihood of withholding personal health information from a provider. A fully interacted multivariate model was used to compare associations between the 2 years, and interaction terms were used to evaluate trends in the factors that are associated with withholding behavior.
  
  
  
  No difference was found regarding the effect of privacy and security concerns on withholding behavior between 2011 and 2014. Similarly, whereas perceived high quality of care was found to reduce the likelihood of withholding information from a provider in both 2011 (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.56-0.94) and 2014 (OR 0.61, 95% CI 0.48-0.76), no difference was observed between years.
  
  
  
  These findings suggest that consumers' beliefs about EHR privacy and security, the relationship between technology use and quality, and intentions to share information with their health care provider have not changed. These findings are counter to the ongoing discussions about the implications of security failures in other domains. Our results suggest that providers could ameliorate privacy and security by focusing on the care quality benefits EHRs provide.
authors.affiliation: Department of Family Medicine, The Ohio State University, College of Medicine, Columbus, OH, United States.
authors.forename: Daniel M
authors.identifier: 0000-0001-5434-3162
authors.initials: DM
authors.lastname: Walker
authors.affiliation: Department of Family Medicine, The Ohio State University, College of Medicine, Columbus, OH, United States.
authors.forename: Tyler
authors.identifier: 0000-0001-8746-9706
authors.initials: T
authors.lastname: Johnson
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Eric W
authors.identifier: 0000-0002-7885-0019
authors.initials: EW
authors.lastname: Ford
authors.affiliation: Department of Family Medicine, The Ohio State University, College of Medicine, Columbus, OH, United States.
authors.forename: Timothy R
authors.identifier: 0000-0002-9978-3564
authors.initials: TR
authors.lastname: Huerta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003219:Confidentiality / Q000941:ethics*; D003430:Cross-Sectional Studies; D030881:Disclosure; D057286:Electronic Health Records; D005260:Female; D055991:Health Records, Personal / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018907:Privacy / Q000523:psychology*; D011787:Quality of Health Care; D035502:Trust; D055815:Young Adult
keywords: disclosure; electronic health records; electronic medical records; personal health information; privacy; trust