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Attitude and Opinion Research
eHealth Initiative
Work in Support of the Gulf Coast Task Force
Slide 2
Figure 1. Gulf Coast Health Information Task Force
Slide 3
FeHI GulfCoast
Team Initial Messages
Consumers
Consumers
Physicians
Physicians
Employers/ Purchasers
Step 2: Conduct Focus Group Research
Step 3: Conduct Quantitative Telephone Research
Step 1: Develop Initial Key Messages
Employers/ Purchasers
Step 4: Analyze Research Results to Inform Final Key Messages
June 2006 July 2006 Aug 2006 Sept-Dec 2006May 2006
Step 5: Finalize Key Messages for Media/ Education Kit & Dissemination Plan
AL Sample
FL Sample
LA Sample
MS
MS Sample
TX Sample
Source: Health2 Resources, 2006
►Media Outreach Tools
►Shared Graphics
►Tools to Support Marketing
Activities
►Tools to Support Partnership Development
►Resources, Research, Real Examples
An overall summary presentation of the written exercises from six focus groups conducted June 20-22, 2006.
Slide 5
On behalf of E-Health Initiative, Public Opinion Strategies conducted six focus groups among primary care physicians, consumers, and employers in the following locations and dates:
Houston, TX June 20, 2006Eight physiciansNine consumers
Mobile, AL June 21, 2006Nine small business ownersEight consumers
Tampa, FL June 22, 2006Eight employee benefits managers in larger companiesEight physicians
Slide 6
Audiences Defined• Consumers
– Male and female– Registered voters, likely to vote in this year’s election– Age 25-74– High school graduate or higher– Household income of at least $25,000
• Employers– Small business owners, 4-50 employees providing at least some portion
of health insurance benefits for FTE Age 30-74 with at least some college, personal income of at least $40K women, $60K men
– Benefit Managers were persons responsible for making decision on health care coverage in business with over 100 employees paying at least some portion of health insurance benefits. In position for at least a year. Same age and income as Small Business.
• Physicians– Mix of internists, general practitioners, OB/GYN's and pediatricians.
Residents and interns were excluded.
Slide 7
Respondents in all groups were asked a series of questions about their technology use and attitudes to adopting new technology. Based on their responses they were categorized as being "tech-savvy" or "not tech-savvy." There was a mix of "tech savvy" and "not tech-savvy" participants in each group.
As a group, participants were asked to share exactly what they think is in their medical record*.
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* Only asked among Consumers and Employers
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Consumers Employers Past history and medical history (2) Allergies (2) Comments from doctor and visit history (2) Blood pressure and temperature (2) Prescriptions/Medications (2) Emergency numbers and contacts Doctors names Diseases Insurance information/payment information Attitude Date of birth/age Social Security number Gender Current complaint/illness Height and weight Test results Concerns with each visit Medical conditions Illnesses and surgeries
Prescriptions (2) Tests Blood type Social Security number Cholesterol and blood pressure Diseases Family history Doctors comments Personal data- weight, height, vital signs Symptoms Diagnoses and treatments Office visit history Billing information Allergies Medical history Insurance status
What exactly do you think is in your medical record?
1. Participants were asked to write down what the phrase “Health Information Exchange” means to them.
2. Then they were asked for their reaction to the phrase “Health Information Exchange.” They were asked if they felt positive (thumbs up), negative (thumbs down), or neutral (thumbs sideways) towards the phrase.
3. Next, as a group, participants brainstormed questions they would like someone to answer about “Health Information Exchange” and what they would like to know more about.
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“A forum for exchanging information regarding health issues. This could be between patients, patient-physician, physician-physician or pharmaceutical reps to patients.”
“A form of medical information storing via different methods, be it courier, Internet or phone.”
“I think it is speaking of exchanging of information with other providers, health insurers or other affiliates of the medical field having to do with your health issues.”
“Receiving and providing health information (specific details) with someone else, doctor or receiving from the Internet.”
Please write down what the term “health information exchange” means to you.
Consumers
Slide 12
“I think that this term: Health Information Exchange means that in the future your doctor will be able to access your previous health information if you’ve switched practitioners.”
Doctors can cross reference past histories, medications, and if all bills were paid by insurance company.”
“Transfer of medical records from one doctor’s office to the next. Also information that is sent to insurance company’s, patient to doctor conversations.”
“The ability for doctors to exchange information on a patient, to consult other doctors on test results or conditions, symptoms that a patient is having.”
Please write down what the term “health information exchange” means to you.
Consumers
Slide 13
“Communication between the patient or participant and the health care provider or administrator of a plan.”
“Health information. The exchange of health information via computer, electronically.”
“Sharing of patient data with other authorized care providers.”
“General health information provided by health insurance carriers on common health conditions and possible treatment options.”
Please write down what the term “health information exchange” means to you.
Employers
Slide 14
“Exchange of information to assist in the best possible healthcare.”
“Reporting diagnosis, care, treatment, medications and other health care information to another person or group.”
“Health data transferred to and from like EDI (Electronic Data Interchange)”
“Being able to share health information between doctors, pharmacy, and insurance companies.”
“I don’t know.”
Please write down what the term “health information exchange” means to you.
Employers
Slide 15
“Flow of data between providers and between providers and patients. Payers may also be included in this.”
“Transfer of medical information from one place to another or from one provider to another.”
“Exchanging health information between other physicians, health care companies, insurance companies, hospitals and patients to allow integrating this information easily.”
“The systems used to exchange information between providers and patients in the healthcare system.”
“information between doctors, hospitals, different consultants, and labs.”
“Conveyance of patient health data to insurance companies, other physicians, schools, home care providers, etc. for clinical or financial reasons.”
Please write down what the term “health information exchange” means to you.
Physicians
Slide 16
“Electronic transfer of patient data between hospitals and physicians. Physician to physician discussion of patient data. Discussion of patient information to the patients themselves by the physicians.”
“Ability to retrieve information on any patient at any time without any restrictions (the anathema of HIPAA).”
“Free exchange of patients’ data between individual entities.”
“Being able to ascertain health information from patients, other doctors, hospitals, labs, diagnostic centers, in a timely and efficient manner.”
“Ability to consolidate all sources of information about a given patient into a central information system, i.e. labs, medical information, medicine, tests, etc.”
Please write down what the term “health information exchange” means to you.
Physicians
Slide 17
Consumers Employers Physicians Total
Positive 10 15 7 32
Neutral 7 1 9 17
Negative 0 1 0 1
What’s your reaction to the phrase “Health Information Exchange”… thumbs up/positive, thumbs sideways/no strong feelings one way or the other, or thumbs down/negative?
Slide 18
Consumers Employers Physicians What type of information is
exchanged? (2) Who is the exchanging with? (2) How does HIPAA impact this? Is there confidentiality from
insurance companies, employers, and prescription companies?
What is it? Is this going on already?
How does HIPAA play into it? Who is the exchange between? What information is being
exchanged? How is information exchanged? Is
it electronic? How long will it take to happen? Who owns the information? Who has access? Would
employers have access? How secure is the information
exchange? How is access restricted? Who determines what information
is shared with whom? Is there any individual say in what
is shared? Will there be any solicitations? Will patients have to give
permission for the information to be shared?
Is this a free service? (2) Is the exchange 100% secure? (2) Who has access? (2) Exchange between who? How accurate is the information? Privacy- Is it protected? What is the speed and ease of
exchange? Is the data available for statistics? What about possible discrimination
and abuse by employers? What is my liability? How will we get trained? What is
the cost of training? How dependable is it and how long
will it last? How easy will it be to use? Is there support and/or backup for
problems? Will it be a universal system?
Questions about Health Information Exchange
Then participants read a description of health information exchange (on the next slide) and then were asked to rate it
on two scales.
1. They were asked to rate their overall opinion about health information exchange on a scale from 1 to 100, with 1 being very unfavorable and 100 being very favorable.
2. They were asked how likely they would be to actually USE this service, again, on a scale from 1 to 100 with 1 being not at all likely to 100 being extremely likely to use this service.
After they read the description they were asked as a group what other questions they have about the service.
Slide 19
Health information exchange is a way to electronically move your personal health and medical information through a secure online account between various health care providers. Only with your permission can your medical information be shared through this service. Health information exchange allows you to make sure your health information is available when and where you need it while seeking medical care or treatment.
Health Information Exchange Description:
Slide 20
Slide 21
Consumers Employers Physicians Total
Overall Impression 79 83 77 80Likelihood to Use 74 81 65 73
Please rate your overall opinion about health information exchange on a scale from 1 to 100, with 1 being very unfavorable and 100 being very favorable.
1 10 20 30 40 50 60 70 80 90 100Very Unfavorable Neutral Very Favorable
Please rate how likely you would be to actually USE this service, again, on a scale from 1 to 100 with 1 being not at all likely to 100 being extremely likely to use this service?
1 10 20 30 40 50 60 70 80 90 100Not At All Neutral ExtremelyLikely Likely
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Consumers Employers Physicians Who has access to the information?
(2) How secure is secure? Do insurance companies have
access to the information? What makes it secure? Are there
passwords? Who has the passwords? How often is security tested, checked
and updated? Would I personally be able to see the information?
Would your payment history and/or schedule be seen?
How long is it available on line? 5 years, 10 years, forever?
Would I have an account or is it in each doctors office? How is it set up?
Who pays for it? Would you have to subscribe? Will there be a back-up- specifically
in hard copy? Where is the information coming
from? Who inputs the information? Will the system be global? National?
Regional?
Are you able to retrieve or view your information?
What health care providers can see it and why would two insurers share information?
What role does HIPAA play? Where is information? One
database? or many companies? or my doctor keeps it?
Who would be able to get this information?
How will security be handled? Will there be open authorization or
on a one time basis? Who initiates the exchange? The
patient or doctor? How does the person receiving the
information know it is trustworthy and not fraud?
Will medical or personal information or both be shared? Only medical history?
How well is it explained to patients? Do they understand what they’re giving permission for?
How long is information kept for?
How is it set up? What will it cost? How is it secure? How are we going to learn how to
use it? Are Mac’s compatible? Is it just used for heath care or
can it be used in court or for other purposes?
Do patients have access to it? Are doctors protected from
liability?
Other Questions about Health Information Exchange
Slide 23
Participants were handed two sets of messages and were asked to choose the top two messages which gave them the most favorable opinion of health information exchange from
each set. They were then asked to circle the top two messages across the two sets from their top four messages selected. We tested the same 15 messages across all three target audiences, with only slight variations in wording to reflect the type of audience. We also tested an additional
message only among employers and one only among physicians. All of the messages tested are listed on the
following slides by type of respondents.
Slide 24
Message Consumers Employers Physicians Total
J. Allow physicians to share critical health information 10 12 11 33
K. Enable physicians to have must up-to-date/ accurate health information even if patient forgets 10 6 11 27
S. Allow physicians to access right medical information at the right time 9 10 8 27
O. Up to $500 billion spent on duplicative care, will cut costs by cutting paperwork and repeat tests 6 6 9 21
Q. Our country has highest death rate due to medical errors- will reduce errors and save lives 6 8 5 19
R. Provide immediate access to health information in an emergency 7 5 2 14
N. Ability to review your health information and provide input 7 5 2 14
H. Electronic storage means information is legible 2 3 5 10
Top Four Messages
Please write down the letter of the TWO messages in each stack which give you the most favorable opinion of health information exchange.
Slide 25
Message Consumers Employers Physicians Total
J. Allow physicians to share critical health information 5 10 7 22
S. Allow physicians to access right medical information at the right time 7 6 3 16
Q. Our country has highest death rate due to medical errors- will reduce errors and save lives 5 6 4 15
K. Enable physicians to have must up-to-date/ accurate health information even if patient forgets 3 2 10 15
O. Up to $500 billion spent on duplicative care, will cut costs by cutting paperwork and repeat tests 2 3 3 8
R. Provide immediate access to health information in an emergency 2 3 2 7
N. Ability to review your health information and provide input 4 2 0 6
V. Health care information today in highly fragmented decentralized paper form 2 1 0 3
L. Provides back-up system for the unexpected 2 0 1 3
Top Two Messages
Please circle the top two messages among the four you have listed above.
Slide 26
Message that Resonated Highest With Consumers “S”
“A health information exchange will allow physicians to access the right medical information at the right time In an emergency, getting a patient’s medical records quickly could mean the difference between life and death.”
Slide 27
Message that Resonated Most With Employers “J”
“A health information exchange allows all of your physicians to share critical health information that may impact decision making for treatment.”
Slide 28
Message that Resonated Most with Physicians “K”
“Patients have difficulty remembering important medical information which may affect the health care they receive. A health information exchange will enable physicians to have the most up-to-date and accurate health information needed in order to properly care for their patients.”
Slide 29
Overall the research concluded that in talking to physicians, consumers and employers about health information
exchange….
Focus on:• Security;• How it works;• Patient permission;• Who has access; and• The benefit to the patients and physicians
Slide 30
Participants were asked to re-rate their overall opinion about health information exchange on a scale from 1 to 100, with 1 being very unfavorable and 100 being very favorable, and to re-rate how likely they would be to actually USE this service on a scale from 1 to 100 with 1 being not at all likely to 100
being extremely likely to use this service.
They were then asked to write down some reasons they feel they way they do about the exchange.
Slide 31
“Very important during/after a natural disaster. In the event of an emergency this would be great if one was alert.”
“I think it is a great idea. It would benefit everyone in an emergency situation. There are always risks and problems to work through getting information to the right people and only to those with access.”
“I think the HIE would be for the most part a good thing. As long as certain security access guidelines are set up.”
“Would be o.k. – favor heavy government regulation government-controlled. Age-discrimination has not been addressed, will be used by employers to block individuals.”
“One reason I feel neutral about HIE is the access ability, who will be able to access my files. Another reason would be just in case of an emergency, would this information be available?”
“I’m not so sure other sources like attorneys and insurance companies could access this information also.”
Consumers
Slide 32
“Seems like a pretty good idea – we need to continue to explore ideas on how to be more open to new technology and efficiency. GOOD LUCK and thanks for getting our input in the process of your planning.”
“Great idea, but I don’t think that it would ever come to be in my time.”
“I want medical professionals to be able to retrieve my records in an emergency situation.”
“Speed of the process and information to the people who need it.”
“All my doctors would have access to all of my medical history. In an emergency, ER would have access to my records. HIE would help everyone participating during a disaster.”
“Great way for health information to get from doctor to doctor to improve treatment; and for use in emergency (personal, regional, etc.).”
“Very important during/after a natural disaster. In the event of an emergency this would be great if one was alert.”
Consumers
Slide 33
In conclusion, participants were asked to write down the one or two things they heard during the group that
convinced them of the importance and need for health information exchange.
Slide 34
“Health information is available in the event of a health issue/health history.”
“Available when needed. Critical decisions would be able to be made with historical information and personal data.”
“The one or two things of importance that I heard would be because of the emergency ability and also if my family had a history of let’s say diabetes, I would be able to pick up or read up on the symptoms my mother had.”
“information exchange to reduce medical errors. information available during emergency.”
“Needing emergency care when you’re sick (be available).”
“Travel from state to state, you may need health care information, hurricanes, storms”
“Out of town emergency. Disasters and destruction.”
Consumers
Slide 35
“Disaster Recovery – I do not have a plan for what to do or any records available for portability. Doctors Doctors’ communication is vital – let’s try to help them so they can help us!”
“Duplication of information wasting money; ability to access information myself – Assurance that system would be secure.”
“Possible storage of vital (only) medical information for emergency needs.”
“When I heard the name I knew what it was going to be and was convinced it was a good thing.”
“Me going to an emergency room not in my area or state, etc. and having an authorized person to get important information needed that might assist in saving my life.”
“Ability to share through a network.”
“Life and death situations. Natural disasters. Cost savings.”
Consumers
Slide 36
Next Steps
Slide 37
Step 4: Analysis of Research Results and Development of Final Messages
Step 5: Messages for Media/Education Kit; Refinement of Communication Channels
Media Outreach Tools
Tools to Support Employer Communications
Tools to Support Partnership Development
Resources, Real Examples
Shared Graphics
