The Process of Building Patient Trust in Health Information Exchange (HIE): The Impacts of Perceived Benefits, Perceived Transparency of Privacy Policy, and Familiarity

Exchange technologies such as health information exchanges (HIE) currently lack acceptance theories that consider not only cognitive beliefs that result in adoption behavior but also emotional factors that may influence adoption intention. Based on the theory of reasoned action (TRA), the technology-adoption literature, and the trust literature, I theoretically explain and empirically test the impact that perceived benefits, perceived transparency of privacy policy, and familiarity have on cognitive trust and emotional trust in HIE. Moreover, I analyze the effect that cognitive trust and emotional trust have on individuals’ intention to opt into HIE and their willingness to disclose health information. I conducted an online survey using data from individuals who knew about HIE through experiences with providers that participated in a regional consumer-mediated HIE network. In my SEM analysis, I found empirical support for the proposed model. My findings indicate that, when patients know more about HIE benefits, HIE sharing procedures, and privacy guidelines, they feel more in control, more assured, and less at risk. The results also show that patient trust in HIE may take the forms of intentions to opt in to HIE and patients’ willingness to disclose personal health information that providers exchange through the HIE. I discuss the implications my results have for both academics and practitioners

Better Patient Privacy Protection with Better Patient Empowerment about Consent in Health Information Exchanges

Since HIPAA laws have permitted broad discretion to Health Information Exchange (HIE) providers, HIEs have configured the patient healthcare consent process to privilege all providers who sign up with the Health Information Exchange with patient health information (PHI) on all consenting patients. This in a sense violates the security principle of “least privilege”. The onus of denying broad based general access for a consenting patient, now resides with the patient. The notion of making the information available to all physicians at all times because they are part of an exchange is not the best practice. Patients empowered with the right information may choose to deny access to their medical records while seeking a second opinion. This research investigates the following questions: How does a more holistic education as opposed to a one-sided message impact patient consent behavior? How does the messaging framework impact the intention to consent under different sharing settings? Utilizing an experimental survey, our results show that the binary setting (share all PHI with all providers) was the least favorable among all participants, while the customized setting was the most favorable

Can Offering Patients’ Access to PHR Improve the Sustainability of HIEs?

Health Information Exchange (HIE) are multi-sided platforms that facilitate the sharing of patient health information between providers, payers, etc. across organizations within a region, community or hospital system. HIE benefits to payers and providers include lower cost, faster services, and better health outcome. These benefits are not achieved unless patients consent to share their records. In this research we investigate if HIEs can increase consent rates by offering PHR services to patients and making them active participants in the HIE system. The paper makes a theoretical contribution to research by extending the UTAT model with two types of trust that are critical for patient consent. The findings impact practice. Utilizing 395 participants in a randomized experimental survey design and multi-group invariance structural equation modeling (SEM) we find that PHR will help sustain HIE. In addition, PHR empowers trust in the system and the users

Blockchain Regulations and Decentralized Applications: Panel Report from AMCIS 2018

Blockchain represents one of the 21st century’s most impactful inventions. In addition to creating cryptocurrencies such as Bitcoin, this technology enables smart contract functionality and supports decentralized, secure, and private transactions. By design, blockchains enable decentralized functionality for many of today’s business applications and transform traditional centralized information systems. In this paper, we summarize four research areas that will appeal to IS scholars that a panel at AMCIS 2018 discussed: 1) cryptocurrency regulation, 2) Etherisc (a smart contract-based application), 3) decentralized blockchain applications in healthcare, and 4) Bitcoin as a blockchain application and issues with decentralization. To account for the European Union’s General Data Protection Regulation’s requirements to provide people with the right to be forgotten and modify personal data, we modified Pedersen et al.’s (2019) framework to accommodate off-chain data storage requirements. We deployed Pedersen et al.’s (2019) modified framework to evaluate whether one can use blockchains for three different applications. We summarize several research questions and present a research agenda that emerged from the issues highlighted during the panel discussion

Medical Records and Privacy Rights: The Unintended Consequences of Aggregated Data in Electronic Health Records

In an era of rapid-pace technological innovation and political focus on healthcare, the federal government is pushing for nationwide interoperability of electronic health records. While there are many benefits from such a program, the lack of federal or state privacy regulations for patients\u27 personal data opens up the possibility of widespread dissemination of private and sensitive information. This inattention to privacy will cause major problems if exploited. Currently, there are no federal or Colorado laws that protect against potential privacy violations and provide recourse for a patient if a medical professional decides to insert nonmedical information, such as information about the patient\u27s housing status, into a patient\u27s electronic health record without the patient\u27s prior consent. Although innocuous enough when only the doctor has access to this record, with the increased use of health information exchanges, this information can be disseminated to thousands of healthcare providers around the country. This Comment argues that a comprehensive privacy protection act is critical and long past due for patient protection in the quickly evolving intersection of health care and technology

Health IT Legislation in the United States: Guidelines for IS Researchers

In this tutorial, I review the most pressing legal issues that health information systems (IS) professionals face and how health information technology (IT) legislation drive them. The issues I discuss include the confidentiality and security of electronic protected health information, meaningful use of health IT, health information exchanges, and information governance. I also provide directions for future research

Diffusion of Electronic Health Records in Rural Primary Care Clinics

By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants\u27 experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices