Are Your Patients Reluctant to Share PHI?

Patient and provider education is a crucial factor in facilitating PHI sharing.

When patients consent to share their personal health information electronically with providers they can help enable collaboration among multiple healthcare providers and avoid redundant testing; however, patients might worry about the privacy and protection of their information, how it will be used, and with whom it will be shared.

That's why education—among both patients and providers—is key to facilitating PHI sharing, according to a new study in the Journal of Medical Internet Research.

"If healthcare providers give patients a better understanding of how they're being protected, then patients will be more secure and more willing to share that personal health information," says Joana Gaia, PhD, one of the study authors and clinical assistant professor of the Management Science and Systems Department at the University at Buffalo School of Management.

Researchers analyzed results of a nationwide health survey of more than 1,600 participants using Health Information National Trends Survey data. The survey included questions about health conditions and lifestyles, intention to share personal health information, and more.

The researchers found that privacy concerns had the most influence on patients' decision to share their information.

Gaia calls the privacy concern the study's "unsurprising surprise."

"This seems to be so well known, but there are so few studies out there on this, and these are still concerns that are not addressed with the patient," she says.

Gaia says there are actions that healthcare organizations and individual providers can take to encourage patients to share their PHI.

Instead of just focusing on the positives and the benefits of electronic sharing, conversations with patients and PHI consent forms should include information about what steps an organization has taken to protect patients and their information.

"It's more of an informational step that I think would go a long way," she says.

In addition to concerns about patient privacy, the researchers also found that certain patient traits predicted their intention to share.

For instance, patients with higher issue involvement, such those who have a serious disease, have multiple comorbidities, or see more specialists, have a higher tendency of sharing their information, Gaia says.

On the other hand, patients who are relatively healthy and visit the doctor infrequently might be less likely to do so.

"It's harder to see the direct benefit because there's less issue involvement," she says.

The researchers found that certain "unstable traits," (traits that might change) such as issue involvement and patient-physician relationship are significant predictors of a patient's sharing intention.

That's why physician education around this issue is important as well. Gaia says healthcare providers should focus on those unstable traits in their patients to help influence whether those patients share their PHI.

"Patients are still treated as predetermined subjects," she says. A new approach would be for healthcare providers to recognize that all patients are different and have different concerns, therefore they might need different kinds of guidance and information when deciding whether to share PHI.

"It's kind of tailoring an approach," she says.

After having defined factors and traits that affect patient intention, Gaia said the next study will try to figure out "how we can use those traits to get [patients] to share their information."

For example, the researchers might look at message framing to figure out how positive versus negative messages would affect the sharing behavior of patients. A sample message might be: "If you share your information, you're going to incur less cost and have a smaller likelihood of misdiagnosis" versus "If you don't share your information, your healthcare costs and risks of misdiagnosis are higher."