Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States

While the new Health Insurance Privacy and Accountability Act (HIPAA) research rules governing privacy, confidentiality and personal health information will challenge the research and medical communities, history teaches us that the difficulty of this challenge pales in comparison to the potential harms that such regulations are designed to avoid. Although revised following broad commentary from researchers and healthcare providers around the country, the HIPAA privacy requirements will dramatically change the way healthcare researchers do their jobs in the United States. Given our reluctance to change, we risk overlooking potentially valid reasons why access to personal health information is restricted and regulated. In an environment of electronic information, public concern, genetic information and decline of public trust, regulations are ever-changing. Six categories of HIPAA requirements stand out as transformative: disclosure accounting/tracking, business associations, institutional review board (IRB) changes, minimum necessary requirements, data de-identification, and criminal and civil penalties.

Download Full-text

The future state of patient engagement? Personal health information use, attitudes towards health, and health behavior

Health Services Management Research ◽

10.1177/0951484819845840 ◽

2019 ◽

Vol 32 (4) ◽

pp. 199-208

Author(s):

Kristine R Hearld ◽

Larry R Hearld ◽

Henna Budhwani ◽

Deirdre McCaughey ◽

Leandra Y Celaya ◽

...

Keyword(s):

Health Status ◽

Health Behaviors ◽

Health Information ◽

Perceived Health ◽

The United States ◽

Personal Health Information ◽

Personal Health ◽

Perceived Health Status ◽

Preventative Health ◽

Patient Confidence

The past decade has given rise to interest in the effects of health care information on personal well-being. However, investigations to-date typically centered on mass communication programs in health rather than on individuals’ psychosocial characteristics, agency, and behaviors associated with their engagement with this information. Considering this gap, we examined whether the availability of personal health information is associated with health prevention behaviors in the United States. Using multivariable path analysis and data from the 2017 Health Information National Trends Survey, we investigate whether the use of personal health information is associated with positive, preventative health behaviors (healthy eating, tobacco smoking, and exercise), and if this relationship is mediated by patient confidence in their ability to care for themselves and by their self-perceived health status. Findings indicate that the use of health information, at low levels, is important for improving patient attitudes regarding their health status and confidence in caring for themselves. Perceived health-status and patient confidence, in turn, are associated with preventative health behaviors. Notably, too much information does not necessarily result in positive health behaviors among patients. Organizations may wish to critically assess how much information they make readily available to the populations they serve.

Download Full-text

Differences in Electronic Personal Health Information Tool Use Between Rural and Urban Cancer Patients in the United States: Secondary Data Analysis

JMIR Cancer ◽

10.2196/17352 ◽

2020 ◽

Vol 6 (2) ◽

pp. e17352

Author(s):

Alexandra Greenberg-Worisek ◽

Liaa Ferede ◽

Joyce Balls-Berry ◽

Ian Marigi ◽

Emily Valentin Mendez ◽

...

Keyword(s):

Health Care ◽

Information Technology ◽

Cancer Patients ◽

Health Information Technology ◽

Health Information ◽

Health Care Providers ◽

Personal Health Information ◽

Personal Health ◽

Care Providers ◽

Rural And Urban

Background Studies have previously shown that rural cancer patients are diagnosed at later stages of disease. This delay is felt throughout treatment and follow-up, reflected in the fact that rural patients often have poorer clinical outcomes compared with their urban counterparts. Objective Few studies have explored whether there is a difference in cancer patients’ current use of health information technology tools by residential location. Methods Data from 7 cycles of the Health Information National Trends Survey (HINTS, 2003-2017) were merged and analyzed to examine whether differences exist in managing electronic personal health information (ePHI) and emailing health care providers among rural and urban cancer patients. Geographic location was categorized using Rural-Urban Continuum Codes (RUCCs). Bivariate analyses and multivariable logistic regression were used to determine whether associations existed between rural/urban residency and use of health information technology among cancer patients. Results Of the 3031 cancer patients/survivors who responded across the 7 cycles of HINTS, 797 (26.9%) resided in rural areas. No difference was found between rural and urban cancer patients in having managed ePHI in the past 12 months (OR 0.78, 95% CI 0.43-1.40). Rural cancer patients were significantly less likely to email health care providers than their urban counterparts (OR 0.52, 95% CI 0.32-0.84). Conclusions The digital divide between rural and urban cancer residents does not extend to general ePHI management; however, electronic communication with providers is significantly lower among rural cancer patients than urban cancer patients. Further research is needed to determine whether such disparities extend to other health information technology tools that might benefit rural cancer patients as well as other chronic conditions.

Download Full-text

eHealth patient-provider communication in the United States: interest, inequalities, and predictors

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw087 ◽

2016 ◽

Vol 24 (e1) ◽

pp. e18-e27 ◽

Cited By ~ 6

Author(s):

Kiara K Spooner ◽

Jason L Salemi ◽

Hamisu M Salihu ◽

Roger J Zoorob

Keyword(s):

United States ◽

Health Care ◽

Health Information ◽

The United States ◽

Personal Health Information ◽

Provider Communication ◽

Care Providers ◽

Objective Health ◽

Internet Users ◽

Patient Provider Communication

Objective: Health-related Internet use and eHealth technologies, including online patient-provider communication (PPC), are continually being integrated into health care environments. This study aimed to describe sociodemographic and health- and Internet-related correlates that influence adult patients’ interest in and electronic exchange of medical information with health care providers in the United States. Methods: Nationally representative cross-sectional data from the 2014 Health Information National Trends Survey (N = 3677) were analyzed. Descriptive statistics and multivariable regression analyses were performed to examine associations between patient-level characteristics and online PPC behavior and interests. Results: Most respondents were Internet users (82.8%), and 61.5% of information seekers designated the Internet as their first source for health information. Younger respondents (<50 years), Hispanics, those from higher-income households, and those perceiving access to personal health information as important were more likely to be interested in online PPC. Despite varying levels of patient interest, 68.5% had no online PPC in the last year. However, Internet users (odds ratio, OR = 2.87, 95% CI, 1.35-6.08), college graduates (OR = 2.92, 95% CI, 1.42-5.99), and those with frequent provider visits (OR = 1.94, 95% CI, 1.02-3.71) had a higher likelihood of online PPC via email or fax, while Hispanics and those from higher-income households were 2–3 times more likely to communicate via text messaging or phone/mobile apps. Conclusion: Patients’ interest in and display of online PPC-related behaviors vary by age, race/ethnicity, education, income, Internet access/behaviors, and information type. These findings can inform efforts aimed at improving the use and adoption of eHealth technologies, which may contribute to a reduction in communication inequalities and health care disparities.

Download Full-text

Personal Derived Health Information: A Foundation to Preparing the United States for Disasters and Public Health Emergencies

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.2012.21 ◽

2012 ◽

Vol 6 (3) ◽

pp. 303-310 ◽

Cited By ~ 3

Author(s):

Cheryl Irmiter ◽

Italo Subbarao ◽

Jessica Nitin Shah ◽

Patricia Sokol ◽

James J. James

Keyword(s):

Public Health ◽

Health Information ◽

Expert Panel ◽

First Responders ◽

The United States ◽

Public Health Emergency ◽

Personal Health Information ◽

Personal Health ◽

Great Effort ◽

Public Health Response

ABSTRACTBackground: In the days following a disaster/public health emergency, there is great effort to ensure that everyone receives appropriate care and lives are saved. However, evacuees following a disaster/public health emergency often lack access to personal health information that is vital to receive or maintain quality care. Delayed treatment and interruptions of medication regimens often contribute to excess morbidity and mortality following a disaster/public health emergency. This study sought to define a set of minimum health information elements that can be maintained in a personal health record (PHR) and given to first responders/receivers within the first 96 hours of a disaster/public health response to improve clinical health outcomes.Methods: A mixed methods approach of qualitative and quantitative data gathering and analyses was completed. Expert panel members (n = 116) and existing health information elements were sampled for this study; 55% (n = 64) of expert panel members had clinical credentials and determined the health information. From an initial set of six sources, a step-wise process using a Likert scale survey and thematic data analyses, including interrater reliability and validity checks, produced a set of minimum health information elements.Results: The results identified 30 essential elements from 676 existing health information elements, a reduction of approximately 95%. The elements were grouped into seven domains: identification, emergency contact, health care contact, health profile –past medical history, medication, major allergies/diet restrictions, and family information.Conclusions: Leading experts in clinical disaster preparedness identified a set of minimum health information elements that first responders/receivers must have to ensure appropriate and timely care. If this set of elements is used as the fundamental information for a PHR, and automatically updated and validated during clinical encounters and medication changes, it is conceivable that following large-scale disasters clinical outcomes may be improved and more lives may be saved.(Disaster Med Public Health Preparedness. 2012;6:303-310)

Download Full-text

Differences in Electronic Personal Health Information Tool Use Between Rural and Urban Cancer Patients in the United States: Secondary Data Analysis (Preprint)

10.2196/preprints.17352 ◽

2019 ◽

Author(s):

Alexandra Greenberg-Worisek ◽

Liaa Ferede ◽

Joyce Balls-Berry ◽

Ian Marigi ◽

Emily Valentin Mendez ◽

...

Keyword(s):

Health Care ◽

Information Technology ◽

Cancer Patients ◽

Health Information Technology ◽

Health Information ◽

Health Care Providers ◽

Personal Health Information ◽

Personal Health ◽

Care Providers ◽

Rural And Urban

BACKGROUND Studies have previously shown that rural cancer patients are diagnosed at later stages of disease. This delay is felt throughout treatment and follow-up, reflected in the fact that rural patients often have poorer clinical outcomes compared with their urban counterparts. OBJECTIVE Few studies have explored whether there is a difference in cancer patients’ current use of health information technology tools by residential location. METHODS Data from 7 cycles of the Health Information National Trends Survey (HINTS, 2003-2017) were merged and analyzed to examine whether differences exist in managing electronic personal health information (ePHI) and emailing health care providers among rural and urban cancer patients. Geographic location was categorized using Rural-Urban Continuum Codes (RUCCs). Bivariate analyses and multivariable logistic regression were used to determine whether associations existed between rural/urban residency and use of health information technology among cancer patients. RESULTS Of the 3031 cancer patients/survivors who responded across the 7 cycles of HINTS, 797 (26.9%) resided in rural areas. No difference was found between rural and urban cancer patients in having managed ePHI in the past 12 months (OR 0.78, 95% CI 0.43-1.40). Rural cancer patients were significantly less likely to email health care providers than their urban counterparts (OR 0.52, 95% CI 0.32-0.84). CONCLUSIONS The digital divide between rural and urban cancer residents does not extend to general ePHI management; however, electronic communication with providers is significantly lower among rural cancer patients than urban cancer patients. Further research is needed to determine whether such disparities extend to other health information technology tools that might benefit rural cancer patients as well as other chronic conditions.

Download Full-text