attitude and opinion research- media/education kit

Attitude and Opinion Research-Media/Education Kit

Work in support of the Gulf Coast Health Information Task Force

Katherine H. CappsHealth2 Resources

For eHealth InitiativeSeptember18, 2006

Figure 1. Gulf Coast Health Information Task Force

WHAT ARE WE DOING?In order to assess public opinions and attitudes and develop initial messages,

we followed a two step research process to support the work of the Gulf Coast

Task Force:

1. Conducted six focus groups among consumers, employers and primary care physicians in Gulf Coast States; and

2. We tested the messaging developed in the focus groups on a quantitative survey of adults in the Gulf States (Alabama, Florida, Louisiana, Mississippi, and Texas).

FeHI GulfCoast

Team Initial Messages

Consumers

Consumers

Physicians

Physicians

Employers/ Purchasers

Step 2: Conduct Focus Group Research

Step 3: Conduct Research Through Telephone Survey

Step 1: Develop Initial Key Messages

Employers/ Purchasers

Step 4: Analyze Research Results to Inform Final Key Messages

June 2006 July-Aug 2006 Aug 2006 Sept-Dec 2006May 2006

Step 5: Media/ Education Kit - Dissemination Plan

MS

Source: Health2 Resources, 2006

►Media Outreach Tools

►Shared Graphics

►Tools to Support Education

►Tools to Support Partnership Development

►Resources, Research, Real Examples

AL Sample

FL Sample

TX Sample

MS Sample

LA Sample

WHY WE TOOK THESE STEPS AND WHAT THE RESEARCH WAS DESIGNED TO

MEASURE:FOCUS GROUPS…(Qualitative research)

• Explore in-depth different messaging and language in support of the Gulf Coast Task Force

• Focus groups results have provided us invaluable insight into how to structure messages. This qualitative phase of message development was an iterative process in which we constantly reassessed and learned from the previous set of groups, and incorporated that into final messages.

• Upon completion of the qualitative part of the research we designed the most effective messages aimed at both the general public and physicians.

• This type of message testing is a core step in developing effective and successful messages which will eventually be incorporated into a media/education kit.

TELEPHONE SURVEY … (Quantitative research)

• The survey was designed to:– Measure attitudes and opinions about the development of health information

exchange in the Gulf States;– Further test language and messaging to be used in the media/education kits; and– Provide benchmark measures as baseline measurements in support of the Gulf Coast

Task Force.• A quantitative measurement of messaging allows us to feel confident in that we are

moving forward to the development of a media/education kit with the strongest messages possible.

About Health2 Resources

• Public relations and marketing communications firm based in Washington, DC area- founded 1997

• Strategy development, business plan development, customer relationship management, market research

• Focus only on the health care industry and the relationship between purchasers, providers and payers

• Integrated approach to marketing communications, media relations and sales communications

• Representative client list: eHealth Initiative, URAC, JCAHO, National Business Coalition on Health, INSPIRIS, Gordian Health Solutions, Baptist Health System, Pharmacia Corporation, Schering Plough, Procter &Gamble, Miller Brewing, AHC

About Public Opinion Strategies

• Survey research company specializing in corporate, public policy and litigation research with office in Washington, Denver and Los Angeles.

• Established in 1991, more than 7600 research projects, interviewing more than 3 million Americans across the U.S.

• POS has conducted more than 2400 focus groups• Goal of POS is to “Turn Questions into Answers”• Clients include Association of American Medical

Colleges, CDC, DaimlerChrysler, Robert Wood Johnson Foundation, Verizon, WellPoint and the Markle Foundation.

Presentation of key findings from the research conducted in the Gulf

States on behalf of eHealth Initiative.

#06700

http://www.ehealthinitiative.org/default.mspx

1) Conducted six focus groups among the following target audiences:

Primary care physicians

Employers

Consumers

2) Conducted a survey of 1,000 adults in the five Gulf States (200 interviews completed per state: AL; FL; LA; MS; TX)

Slide 9


Understanding public perception and attitudes about secure electronic health information exchange in the Gulf States;

Exploring attitudes, opinions and barriers to the development of secure electronic health information exchange in the Gulf States; and

Determining what language and messaging are most effective in gaining support for secure electronic health information exchange. Slide 10


Understanding public perception and Understanding public perception and attitudes about health information attitudes about health information

exchange in the Gulf Statesexchange in the Gulf States


I am going to read you a phrase you may or may not be familiar with or might not have heard much about. Just based on the words in the phrase, please tell me how you feel about the phrase on a scale of one to one hundred, with one meaning you feel VERY NEGATIVE and one hundred meaning you feel VERY

POSITIVE and fifty meaning NEUTRAL. You can use any number from one to one hundred, the higher the number, the more positive your feelings are about the phrase. The phrase is.... Secure electronic health information exchange

As witnessed in the focus groups, respondents’ initial impression of the term secure electronic health

information exchange is relatively neutral.

Feelings About Secure Electronic Health Information Exchange

12%15%

37%

30%

80-100 51-79 50 1-49

Total 48

AL 46

FL 49

LA 49

MS 45

TX 49

Mean Scores

And if a friend or neighbor asked you to describe to them what the term secure electronic health information exchange means, what might you tell them?

There remains some confusion with respect to the meaning of the phrase “secure electronic health information

exchange.”

Slide 13

Among those who try to explain the meaning, most correctly identify “secure electronic health information exchange” as medical records being stored online/on the Internet/in a database and could be accessed by patients/doctors/hospitals/insurance companies.

For some, they view this as a way for them to access their own medical information, while others thought it would be for health care providers to exchange information/access records.

Some respondents thought the phrase was referring to HIPAA.


• Respondents rating the exchange above 50 feel it would be good for doctors to share medical data and have it be secured online or in an electronic database. Although these respondents were positive, several expressed concern about security.

• Those who offered a neutral rating of 50 mostly said they did not know enough about health information exchange to give it a positive or negative rating.

• Respondents rating the exchange lower than 50 generally expressed concern about how secure their medical information would be and were very skeptical that if their health information was stored electronically that it could actually be secure.

Slide 14

When asked to explain why respondents rated the term “secure electronic health information exchange” what

they did:


Who feels most positively and negatively about secure electronic health information exchange?

People who are confident in the security of health information online;

HH income $100K+

Opinion elites

Women age 18-34

People who say they would be likely to access their health information online

People who quickly adapt to technology

Post graduates

People not likely to access their health information online

People who are not at all confident that health information is secure online

People who are reluctant to adapt to new technologies

Men age 35-54

People who think their doctor has both paper and electronic records

Married women

Retired men age 60+

Age 45-54

Struggling households

Most Negative (30%)Most Positive (23%):

Looking at what adults in the Gulf States already believe is happening related to their own health information:

How does your doctor keep your medical records?

(Among the 82% who have a personal doctor)


How likely is it that your doctor’s medical records have a back-up copy offsite?

(Among the 82% who have a personal doctor)


Is the back-up copy kept…

(Among those who believe their doctors have a back-up offsite)

Exploring attitudes, opinions and Exploring attitudes, opinions and barriers to the development of health barriers to the development of health

information exchange in the Gulf States information exchange in the Gulf States


Language makes a difference.

Health information exchange is a way to electronically move a patient’s personal health and medical information through a secure online account between various health care providers. Only with a patient’s permission can their medical information be shared through this service. Health information exchange allows you to make sure a patient’s health information is available when and where you need it while they seek medical care or treatment.

Health information exchange is a way to electronically move your personal health and medical information securely between your doctors, hospitals and other health care providers when it is needed for your care. With your consent, your health information will be protected and exchanged under current medical privacy and confidentiality standard procedures. Secure electronic 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.

Respondents overall impression of health information exchange becomes significantly more positive when

presented with a brief definition of the term.

Now having heard this description, please tell me how you feel about the secure electronic health information exchange on a scale of one to one hundred, with one meaning you feel VERY NEGATIVE and one hundred meaning you feel VERY POSITIVE and fifty meaning NEUTRAL. You

can use any number from one to one hundred, the higher the number, the more positive your feelings are about it.

12%

36%

48

64

Initial Informed

80-100 Mean

Initial Informed Net Diff

Total 48 64 +16

AL 46 64 +18

FL 49 62 +13

LA 49 65 +16

MS 45 66 +21

TX 49 64 +15

Mean Score By State


70% 68% 67%75% 74%

67%

21% 21% 25%18% 21% 19%

Overall Alabama Florida Louisiana Mississippi Texas

Strongly Favor Total Favor Total Oppose

Support is extremely strong in the Gulf States for the creation of secure electronic health information exchange

as described.

Now if you learned that secure electronic health information exchange is being considered made available in the Gulf Coast states, would you favor or oppose the creation of this type of secure electronic health information exchange in the Gulf Coast states?

+49% +47% +42% +57% +53% +48%

Support For The Creation Secure Electronic Health Information Exchange

38% 36% 37% 44% 40% 32%

69%78%

67%73% 69%

23%15%

24% 20% 22%

StrongRepublicans

(22%)

SoftRepublicans

(14%)

Independents(19%)

SoftDemocrats

(16%)

StrongDemocrats

(23%)


Support for the creation of secure electronic health information exchange is strong across party as described.

Now if you learned that secure electronic health information exchange is being considered made available in the Gulf Coast states, would you favor or oppose the creation of this type of secure electronic health information exchange in the Gulf Coast states?

36% 40% 37% 39% 38%

+46% +63% +43% +53% +47%

Support For The Creation Secure Electronic Health Information Exchange

By Party

Those who rated the exchange positively or favor HIE being made available in the Gulf States gave the following reasons:

• Having doctors and hospitals exchanging the information;• It would be very useful and timely in an emergency;• If you are traveling or in a different state it makes it easier to get

medical help;• It would be convenient, speed up the process and save paperwork;• Easier to transfer medical records;• May reduce health care costs; and,• A handful of respondents in Louisiana and Mississippi noted that if

such an exchange had existed during Hurricane Katrina, many medical problems might have been averted.

Although these respondents were generally positive about the exchange several continued to express concern over how secure the system would be.

Slide 24

FAVOR (70%)/51 OR HIGHER (58%) FAVOR (70%)/51 OR HIGHER (58%)


Most respondents who rate it negatively or oppose it say they:

Are concerned about security and privacy;

Are concerned about hackers getting access; and,

Do not believe anything online is truly secure.

Less frequently respondents mentioned they:

Do not care about the topic or see no need for it as they are healthy and not seeing doctors/hospitals.

Are under the impression it would be run/controlled by the government and this makes them skeptical of their right to privacy.

Slide 25

OPPOSE (21%)/ 50 OR BELOW (40%)OPPOSE (21%)/ 50 OR BELOW (40%)


Although support is strong there are some groups who are less supportive of creating health information exchange in the Gulf States:

• Non-Internet users (63% Favor);

• Seniors (59% Favor);

• Those who are reluctant to adapt to new technology (53% Favor); and

• Those who are not at all confident that health information online would be secure (44% Favor).

Respondents mention the following as benefits of secure electronic health information exchange:

In an emergency, regardless of where you are, doctors/hospitals can immediately get your information;

Speed - very fast access to the information;

Easily available/convenience of availability;

Very helpful when traveling;

Efficient/cost effective;

Ability to access your own information (from anywhere);

Accurate and up-to-date; and,

More clear/legible information than trying to read your doctor’s handwriting.

Slide 27

As we noted in the focus groups, the greatest barrier to adoption among the general public relates to security and

privacy concerns. This echoes as a barrier throughout this data and the open-ends.

Now if medical records and personal health information were to be stored electronically and shared through the internet, how confident are you that those records and information would remain confidential?

ExtremelyConfident

3%

Very Confident8%

SomewhatConfident

31%

Not TooConfident

26%

Not AtAll Confident

31%

Don't Know/Refused

1%

Total 11% 57%

AL 12% 61%FL 10% 57%LA 12% 54%MS 10% 57%TX 9% 57%

Extremely/ Very

Confident

Not Too/ Not At All

Confident

Respondents say they have the following hesitations/concerns about secure electronic health information exchange:

Security/privacy/confidentiality;

Fear of people hacking into the records/system;

Fear of records being lost/misplaced (VA incident mentioned);

Accuracy - the information is only as accurate as the human being entering the data;

Possible misinterpretation of information resulting in improper care/mis-diagnosis; and,

Fear of government involvement.

Slide 29


Who do respondents trust most to deliver them information about secure electronic health information exchange?

This data reinforces how extremely important doctors are to the successful implementation and acceptance of health information

exchange among the general public.

Thinking some more about secure electronic health information exchange, who would you say you would trust the most to provide you with information about health information exchange?

67%

8%

7%

5%

3%

3%

Doctors

Hospitals

Federal Government

Health Insurance Companies

Employers

State GovernmentTrust Most

Trust Most To Provide Information About Secure Electronic Health Information Exchange

DoctorsDoctors..

Determining what language and Determining what language and messaging are most effective in gaining messaging are most effective in gaining

support for secure electronic health support for secure electronic health information exchangeinformation exchange

Having access in an emergency medical situation is clearly seen as the most important reason to have

secure electronic health information exchange.

And thinking about different situations where and when you might want to have secure electronic health information exchange available, which one of the following situations would be most important to you to have this service available to you, your doctors or health care providers?

46%

14%

10%

9%

7%

5% Most Important

Having access in an emergency medical situation

Having access to your medical record when you are out of state

Having access to your medical history when you visit your doctor

Having access during or after natural disasters

Having access to your medication history when you want to refill your

prescriptions

Transferring lab results, reports or x-rays between health care providers

AL 45%

FL 48%

LA 42%

MS 50%

TX 44%

% Having access in an emergency medical

situation by state

We tested messages in support of secure electronic health information exchange. All of the messages we tested worked well. However, looking at intensity, there are clear winners which the majority of respondents find very convincing.

Slide 33

As we found in the focus groups, the strongest message focuses on the urgency of care, the need for secure electronic

health information exchange in making critical treatment decisions, and being the difference between life and death.

Secure electronic 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.

Surprisingly the messages we tested focusing on natural disasters did not test very well in the focus groups. Based on the learnings from the focus groups we redrafted a message on the benefits of having HIE in a natural disaster. The rewritten message rises to the top as one of the more powerful messages.

Slide 35

Health care information today exists in highly fragmented decentralized paper form in a variety of care settings - physician offices, clinics, testing laboratories, pharmacies, and hospitals and so on. How do we respond in an emergency situation to access medical information when an entire infrastructure is destroyed? A health information exchange provides the needed connection to this information securely.

What is the back-up system for a paper medical record if it becomes destroyed, lost or misplaced? A health information exchange provides a back-up system for when the unexpected – like a natural disaster- happens.

We need to be better prepared in cases of emergency including natural disasters such as Hurricane Katrina to be able to retrieve or recover our medical information. Secure electronic health information exchange will allow doctors to work with evacuees and residents so they would have access to medication histories essential for understanding the medical history of their new patients. For pharmacists, it would help reconstruct customers’ medication records and prescription needs. This would help make sure evacuees and residents have access to their medications and treatment when they need it most.

• Other top messages focused on the use of HIE in emergency situations and the impact secure electronic health information exchange has on the quality of care patients receive.

• Messages that did not test as well focused on lowering costs, patient convenience, and patients ability to access to their own record.

The messages work to give respondents an even more positive impression of secure electronic health

information exchange.

Please tell me how you feel about secure electronic health information exchange on a scale of one to one hundred, with one meaning you feel VERY NEGATIVE and one hundred meaning you feel VERY POSITIVE and fifty meaning NEUTRAL. You can use any number from one to one

hundred, the higher the number, the more positive your feelings are about it.

12%

36%

48%48

6470

Initial Informed Final

80-100 Mean


The messages also work to strengthen support, particularly the intensity of support, for the creation of secure electronic

health information exchange in the Gulf States.

If you learned that secure electronic health information exchange is being considered made available in the Gulf Coast states, would you favor or oppose the creation of this type of secure electronic health information exchange in the Gulf Coast states?

70%

79%

21%15%

Initial Final


Support For the Creation Secure Health Information Exchange

38% Strongly

49% Strongly

Useful and could save lives in emergency situations - especially out of state;

Would help doctors and pharmacists better manage health care;

Useful when traveling or in another state;

Useful in the event of a natural disaster;

Having access to medical records at any time, from anywhere; and,

May help reduce the death statistics and be useful for the elderly.

Slide 40

MOVE TO MORE POSITIVE (64%)/FAVOR (12%):MOVE TO MORE POSITIVE (64%)/FAVOR (12%):

Still have concerns about security/privacy/confidentiality;

Skepticism over if it would actually reduce costs or paperwork;

Concern over accuracy of information;

Concern about who maintains the information and how often it is reviewed/updated;

What happens if the computers crash or the data is lost; and,

How would the system work in rural areas?

Slide 41

MOVE MORE NEGATIVE (16%)/OPPOSE (3%)MOVE MORE NEGATIVE (16%)/OPPOSE (3%)

Washington Denver Los Angeleswww.pos.org ● 703-836-7655

Turning Questions into Answers

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Vice [email protected]

Slide 43


attitude and opinion research- media/education kit

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