Canadians, it seems, have a growing infatuation with healthcare information technology, even though, like Americans, they are concerned about privacy and fearful that their healthcare information could be used against them.
Just out in English and French is a new, 107-page report, Electronic Health Information and Privacy Survey: What Canadians Think2007, by the federal IT booster agency, Canada Health Infoway, Health Canada and the Office of the Privacy Commission of Canada.
Researchers contacted 2,469 Canadians age 16 and older in June and July for over-the-phone interviews of about 20 minutes in length.
They gave exceedingly high marks to an oft-cited raison detre for IT in that 87% of respondents agreed with the statement that it is difficult for doctors and other providers to give high-quality care if they dont have timely access to their patients health information.
And while a hard-core 17% consider information about them held by the healthcare system as not very safe and secure, 40% thought it was moderately safe and secure and 39% thought it was safe and secure.
But the survey did note that over the past four years there has been an erosion of trust by Canadians in healthcare professionals, workers and organizations over whether they would keep their information safe and secure.
For example, 46% of Canadians this year reported they have a great deal of trust in their family physicians to keep their data safe and secure, down from 52% in a similar survey in 2004. Nurses (25%), pharmacists (25%), administrative support personnel (22%) and other hospital providers (16%) all had considerably lower scores for a great deal of trust in the 2007 survey, and also saw modest declines of 2 to 3 percentage points in their scores compared with 2004, most within the 2-percentage-point margin of error for the survey.
Near the bottom of the trust rankings were information technology specialists who run the computers scoring just 11% on great deal of trust, above health insurers (9%), but below researchers in the private sector (14%) and universities (12%) and tied with government researchers at 11%. Their scores were relatively unchanged since 2004, except private-sector researchers actually went up 4 points from the earlier survey.
About 37% of respondents indicated they agreed with the statement that I have less protection of my personal health information than I did five years ago, compared with 34% who disagreed with that statement, 25% who picked neither and 4% who either didnt know or didnt respond to the question.
Additionally, 64% of respondents this year agreed with the statement that There are few types of personal information that are more important for privacy laws to protect than personal health information, up from 60% last year and 59% the two preceding years.
Only 4%, or 108 respondents, reported either personallyor having a family member whoexperienced a serious breach in their personal health information privacy. One respondent in this section of the survey commented on receiving a letter for a fundraiser for a specific disease from the hospital where that person had been treated, so someone used the information to see if I would donate money, a marketing use allowed in the U.S. under the federal privacy rule that is part of the Health Insurance Portability and Accountability Act of 1996.
For the breach victims, the experience tended to sour them in answering other survey questions, the report authors noted.
Not surprisingly, individuals reporting breaches are much less likely to believe that their health information is secure, they said. Accordingly, they are also less likely to trust healthcare professionals to keep this information safe.
Despite having a national privacy commissioner, relatively few Canadians (22%) reported they were either clearly aware (12%) or vaguely aware (10%) of the existence of any federal, provincial or territorial institutions to help protect their privacy and personal health information.
The report authors said: While Canadians enthusiasm for privacy laws may be high, overall low levels of familiarity with legislation in this area suggests that many may not be aware of their rights when it comes to the protection of their health information. Moreover, even if they are aware of their rights, it seems that few would know where to turn if they ever experienced a violation of their personal health information.
Canadians are becoming increasingly aware of electronic healthcare IT systems, and 31% of those polled had within the past year an encounter with a practitioner who used some form of electronic health information system. Better than one in three (36%) of those with EHR encounters had an overall positive impression of them compared with 22% who had a mixed or neutral impression. And 53% of Canadians surveyed (up from 43% in 2003) strongly support development of an EHR system that would allow healthcare professionals to be able to access your records no matter where in Canada you are receiving care.
In addition, 78% indicated that they were comfortable with doctors and other healthcare professionals using computers to record and share personal health information within the healthcare system. Just 13% disagreed, 9% were neutral.
Still, pluralities of 45% really worry that their information could be accessed for malicious or mischievous reasons; 42% that their information could be used for purposes little to do with my health; and 37% that those with access to my health information will not follow established privacy and security procedures.
One reason Canadians may have such confidence in healthcare IT even though they have high levels of concerns about privacy is that the Canadian government has done much to ensure that IT systems give patients control over the flow of their information.
Such controls, though increasingly a topic of discussion in U.S. IT policy meetings, are for now, rarely available in the U.S., in part because four years ago the federal government gave so many participants in the healthcare industry such leeway in exchanging healthcare information without patient consent.
The 2003 HHS revisions to the HIPAA privacy rule overturned the earlier HIPAA rule requirement that patient consent be obtained for use of their data for treatment, payment and a broadly construed category, other healthcare operations.
Thus the U.S. stands in marked contrast to controls afforded many Canadians, according to a February report for the U.S. Substance Abuse and Mental Health Services Administration on the use of so-called masking technologies in Canada, the Netherlands and the U.K.
Report co-author Joy Pritts is a privacy lawyer and the founding director of the Center of Medical Record Rights and Privacy at Georgetown University's Health Policy Institute.
Pritts said Canada and the two European countries are all well ahead of the U.S. in setting privacy policies that enable patients to restrict the movement of their healthcare information. In Canada, some form of data-masking is available in all the provinces, according to Pritts.
In Ontario, for example, a program affording emergency departments access to patients prescription drug histories gives patients the ability to opt out of the data-sharing arrangement or mask specific drugs chosen by the patient. Many of the healthcare IT projects in Canada have subsidies from the federal and provincial or territorial governments, but the federal government requires that grantees abide by federal and state privacy laws as a condition for funding.
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