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BUSINESS
OF MEDICINE
Why Do Patients Use EHRs?
By Mohammed Sajedur Rahman and Dana A. Forgione
Electronic Health Records (EHRs) are expected to have a sig- Maybe. Next, Trust. I trust my doctor. I don’t feel a compelling
nificant impact in transforming the healthcare professions. While need to check-up on my EHR data. Maybe that’s dumb, or just
physician practices and healthcare organizations are increasingly plain lazy. I know there are errors in every other electronic record
adopting EHRs (with some federal prompting), we don’t know a I have. So eventually I’ll probably feel compelled to check on my
whole lot about why patients do, or do not, use this potentially EHR info too. But it hasn’t become a problem…at least not yet.
helpful technology. There’s been a lot of EHR research on Which brings us to number three: Priorities. It’s not at the top of
providers, but not very much on patients. my priority list yet. I can hardly keep up with all my emails. I
skim what looks like the most important messages, and have well
That changed recently with a groundbreaking study that fo- over 10,000 emails I’ve never even opened (ouch, this is embar-
cused entirely on patients.1 It used an “integrated causal predic- rassing). I suppose when a problem comes to my attention, I’ll
tive model incorporating theories from Information Systems, get motivated to check my EHR info.
Health Psychology, and Organizational Psychology to understand
the health-related factors as well as technology-related factors in- But now, the real results. Most of the tested factors were statisti-
fluencing patient’s behavioral intention to use EHRs.” That’s a cally significant, but the outstanding issues were … can you guess?
mouthful, but the important issue for addressing meaningful use Information privacy and security concerns. People are worried
of EHRs is that it gets to the heart of patient behavior. about the privacy and safety of their health information. And no
wonder. Healthcare.gov got hacked. The Vermont ACA health in-
The study examined 44 variables, grouped into 12 major cat- surance exchange got hacked, several major health insurance com-
egories: (1) perceived information control, (2) perceived vulner- pany databases got hacked. Why, even the company that produces
ability, (3) perceived severity, (4) perceived self-efficacy, (5) hacking software for government and law enforcement agencies,
perceived health information privacy concerns, (6) perceived itself got hacked! By the way, all their confidential client list info
health information security concerns, (7) perceived health bene- got posted to the Internet and we discovered they were selling their
fits, (8) general health orientation, (9) cues to action, (10) per- hacking software to countries they weren’t supposed to be selling it
ceived severity of illness, (11) behavioral intention, and (12) to. So, maybe hacking the hackers was a good thing…
demographic/control variables. They were framed into a survey
that was subjected to focus-group analyses, pilot testing, and Well, anyway, one variable that had a moderating (but non-
passed with flying colors just about every rigorous validity test significant) effect was “severity of illness (health status emotion)”
know to modern science. Then, with the cooperation of several perception. When a patient gets sick or injured, they go to their
healthcare organizations in the San Antonio area, 368 patients doctor. If they’re severely sick or injured, they’ll have more billing
and other subjects were surveyed, and state-of-the-art statistical and health records issues and thus more motivation for their fam-
analyses were performed. ily or support individuals to check their EHR. The issue with this
one was likely that only one survey question was used to measure
The upshot? Well, first let me tell you my personal (i.e., For- the effect, and it probably should have been multi-dimensional.
gione’s), informal replies: Passwords. Trust. Priorities. What do I Oh well, it shows further work needs to be done in this area and
mean? I mean at last count, I have more than 158 passworded leaves room for future follow-up studies. Researchers have to
venues that I have to keep track of. And they keep changing on work too, you know.
me. I just cannot cope with any more passworded venues. When
I receive an email from my physician about taking a look at my Nonetheless, among the health-related factors, patients’ health
EHR, the minute it asks me to set up a username and password, benefit perceptions were found to have the strongest influence on
I exit. I just can’t cope with any more passwords. Am I a-typical? their behavioral intention to use the EHRs, followed by cues to ac-
40 San Antonio Medicine • October 2015
