The Role of Health Care Experience and Consumer Information Efficacy in Shaping Privacy and Security Perceptions of Medical Records: National Consumer Survey Results

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This is a review for V Patel’s This is a review for R Tamblyn’s The Role of Health Care Experience and Consumer Information Efficacy in Shaping Privacy and Security Perceptions of Medical Records: National Consumer Survey Results[1]


The Health Information Technology [[1]] Act of 2009 put a number of federally funded initiatives in place to support the adoption and “Meaningful Use” of Electronic Health Record (EHRs) by eligible providers, including physicians and hospitals. These included financial incentives, initiatives to develop standards to exchange information electronically, and technical support for providers to adopt and use EHRs. A key and important element, which the HITECH Act also emphasized, was the importance of ensuring patient and provider trust in EHRs and the electronic exchange of health information. The goal of this paper was to answer the three questions below:

1. How confident are adults in the privacy and security of their medical records? What technology-related care experience and patient engagement–related factors are associated with consumer confidence in privacy and security? 2. What proportion of adults have withheld information from their provider due to privacy or security concerns? What technology-related care experience and information efficacy–related factors are associated with withholding information? 3. What are adults’ levels of concern regarding sending health medical information from one provider to another? Does this vary by whether it is sent by fax or electronically, and what differentiates adults who express concerns about these different modes of sharing electronic health information?


Data Collection Health Information National Trends Survey (HINTS). (HINTS) is a nationally representative survey of the US noninstitutionalized adult population (≥ 18 years) that tracks attitudes, knowledge, and behavior related to health and cancer communication and health outcomes, with an emphasis on the evolution of health information technology in health care.

Independent Variables

Respondents reported on the quality of care received in the past 12 months from their health care provider (excellent, very good, good, fair/poor, no health care visits in the past 12 months) and their trust in information provided by a health care provider (a lot, some, a little/not at all).

Technology-Related Variables - An index of Internet activity was created to assess the degree to which respondents were engaged in online behaviors.

Information Efficacy - Information efficacy was assessed with the question “Overall, how confident are you that you could get advice or information about health or medical topics if you needed it?” (completely confident, very confident, somewhat/a little/not at all confident).


In all, 58.58% (2443/3924) of adults reported that over the past 12 months they had received either excellent (28.73%, 1190/3924) or very good quality of care (29.85%, 1253/3924). A quarter of adults reported they were completely confident in their ability to obtain health-related advice or information they needed (25.53%, 1002/3931), whereas more than one-third (38.81%, 1531/3931) reported they were only somewhat, a little, or not at all confident in their abilities to do so. With regards to technology exposure and uptake, approximately one-quarter (26.26%, 957/3621) of adults engaged in some health-related activity online. The majority (83.99%, 3332/3855) reported their providers kept their medical records in a computerized format.


As EHR adoption has increased dramatically, a majority of individuals report they are confident in the privacy and security of their medical records. Three-quarters of adults reported they were either very or somewhat confident in the security of their medical records; similarly, three-quarters of adults reported they were very or somewhat confident in the privacy of their medical records. However, we found evidence suggesting that concerns regarding privacy and security may have a negative influence on provider-patient interactions. In all, 12.33% of adults reported they have withheld information.

The findings also suggest that confidence in the security and privacy of medical records may be associated with perceptions of quality and a sense of engagement with the health care system.


  1. Tamblyn et al. Evaluating the impact of an integrated computer-based decision support with person-centered analytics for the management of asthma in primary care: a randomized controlled trial. JMIR Med Inform . 2015: Feb.