Trust Me, I’m a Doctor: An Empirical Investigation into Factors Influencing the Adoption of e-Health Record Sharing in Hong Kong

Description

Electronic health records (eHR) systems promise a new frontier for improved healthcare quality and safety for patients as well as promoting health system resource efficiency. The benefits of eHR include clinical (reduced medical errors), organizational (providing financial and operational benefits) and societal (improved population health through medical research) improvements. However, because eHR contain longitudinal patient histories meant to be shared for clinical and therapeutic purposes, eHR systems have amplified the concerns surrounding data confidentiality and privacy. An opt-in eHR sharing system (eHRSS) was launched in Hong Kong in March 2016. By April 2019, approximately 1,050,000 patients were registered. Sources referencing enrolment numbers are limited, but based on the available numbers, it appears most of the enrolment with the eHRSS were patients migrating from the Hospital Authority’s old Public Private Interface-Electronic Patient Record one-way patient information sharing program. This reflects difficulties in recruiting new members to join the system. Our pilot study of 25 subjects on the level of patient and public's attitude and trust towards the eHRSS reveals some support for the eHRSS and an overwhelming ‘data trust deficit’. However, given the sample size, the data captured is inadequate and needs to be expanded. EHR are 'socially-critical' communications because the disclosure of personal health information highlights privacy and security concerns that becomes more complex with digitization and the interoperability of health records. If these concerns are not addressed in a way that patients and public understand and accept, the lack of institutional trust will correspondingly result in the sharing of health records lacking social credibility. The correlation of trust to personal privacy and security and the levels of positive attitudes and support towards eHR sharing from Hong Kong's health consumer perspective is an understudied area which warrants greater investigation. Additionally, an investigation into how Hong Kong resolves its own concerns in the broader healthcare efficiency vs privacy trade-off lends its practice out to other jurisdictions. The Project adopts a socio-legal perspective involving comparative and empirical studies. First, the Project will evaluate the extent to which perceived importance of trust, privacy and security can over-ride privacy concerns thereby providing a supportive attitude towards eHR sharing. Second, by comparatively examining key facilitators and barriers in promoting acceptance and use of eHR in the US, Australia, and Singapore against Hong Kong's framework, the Project will examine whether an appropriate ecosystem exists which renders well-intentioned policies and institutional efforts achievable.