Trust and Health Information Exchanges: Qualitative Analysis of the Intent to Share Personal Health Information

What are patient perspectives on privacy and trust in digital genomic tools? A qualitative study

Digital tools have emerged as a promising solution to increase the efficiency and capacity of genomic services. However, accessing information through internet-based applications raises concerns about privacy and security risks. As patient-facing digital tools are developed for genomic medicine, it is vital to understand and incorporate patients' perspectives on digital privacy and security. A qualitative study was conducted using semi-structured interviews and interpretive description. Thirty participants who previously received genetic testing for themselves (n = 17) or their child (n = 13) were interviewed (n = 20 females, n = 15 above 50 years old). Participants were willing to store and access genomics personal health information (PHI) in a patient-facing digital platform. The main benefit identified by participants was the ability to access and control their own PHI. Participants expressed that the benefits of digital genomics services, such as patient empowerment and personalized care, outweighed the perceived risks, such as potential data leaks. In order to minimize risks, participants emphasized the importance of transparency about the security measures in place and who would have access to their PHI. These findings inform the design of digital genomic platforms to enhance patients' sense of security, which is critical for the uptake and usage of any platform.

Heterogeneity in willingness to share personal health information: a nationwide cluster analysis of 20,000 adults in Japan

BACKGROUND

While Personal Health Records (PHRs) are increasingly adopted globally, understanding public attitudes toward health information sharing remains crucial for successful implementation. This study investigated patterns in willingness to share personal health information among Japanese adults and identified factors influencing their sharing decisions.

METHODS

A nationwide cross-sectional web-based survey was conducted among 20,000 Japanese adults in December 2023. Participants were recruited through quota sampling based on age, gender, and prefecture population ratios from the 2020 National Census. The survey examined willingness to share personal health information with nine types of recipients (healthcare providers, ambulance crew, application providers, family members, local authorities, employers, pharmaceutical companies, government agencies, and research institutions), trust levels in these recipients, and 17 factors influencing sharing decisions across health benefits, convenience, economic incentives, social significance, information details, transparency, and privacy considerations. Clustering analysis using Uniform Manifold Approximation and Projection (UMAP) and Ordering Points to Identify the Clustering Structure (OPTICS) algorithms was performed to identify distinct patterns in sharing preferences.

RESULTS

Despite low PHR familiarity (88.4% unfamiliar), participants showed willingness to share health information with healthcare providers (65.0%) and family members (65.6%), but expressed lower willingness toward government agencies (28.6%) and research institutions (28.8%). Five distinct clusters were identified: family-only sharers (3.9%), mixed preference sharers (47.9%), comprehensive sharers (12.9%), non-sharers (22.1%), and healthcare-selective sharers (13.2%). Trust levels were highest for family members (85.6%) and healthcare professionals (78.8%), while significantly lower for government agencies (44.2%). Higher education, income, and PHR familiarity were associated with greater willingness to share, while privacy and security concerns were universal across all clusters.

CONCLUSIONS

The heterogeneous patterns in health information sharing preferences suggest the need for tailored PHR implementation strategies that address varying privacy concerns and trust levels across different population segments. Success in PHR adoption requires balanced approaches to trust-building, robust data protection, and targeted communication strategies that acknowledge diverse user needs while promoting the benefits of health data sharing.

Managing legal risks in health information exchanges: A comprehensive approach to privacy, consent, and liability

Health Information Exchanges (HIEs) are revolutionizing healthcare by facilitating secure and timely patient data sharing across diverse organizations. However, their rapid expansion has introduced significant legal and ethical challenges, particularly regarding privacy, informed consent, and liability risks. This paper critically assesses the effectiveness of existing legal frameworks, including Health Insurance Portability and Accountability Act (HIPAA) and General Data Protection Regulation (GDPR), in addressing these challenges, revealing gaps in their application within HIEs. It argues that current consent models fail to provide meaningful control for patients, while privacy protections are weakened by issues such as re-identification and jurisdictional inconsistencies. Moreover, liability in data breaches remains complex due to ambiguous responsibility among stakeholders. The study concludes that reforms are needed, including dynamic consent models, standardized liability frameworks, and enhanced data governance structures, to ensure secure, ethical, and effective data sharing. These changes are essential to fostering patient trust, improving healthcare delivery, and aligning with Sustainable Development Goal (SDG) 3-ensuring healthy lives and promoting well-being for all.

The perception of facilitators and barriers to the use of e-health solutions in Poland: a qualitative study

BACKGROUND

E-health entails the use of information and communication technologies in support of health and health-related activities. E-health increased significantly during the COVID-19 pandemic in Poland. The pandemic showed that the e-health environment may be an important element of the response to epidemiological challenges. Polish citizens were provided with an array of e-health tools supporting the provision of health services.

METHODS

The main aim of the study was to assess the knowledge, use, and opinions about e-health solutions in Polish society. Fifty participants representing the general population took part in in-depth interviews. The interviews were conducted face-to-face with participants in their homes or via a teleconferencing platform from November 2023 to January 2024. At first, the interviewees were recruited by convenience, and at a later stage, a snowballing approach was applied. A semi-structured guide covered the knowledge about and use of e-health solutions, attitudes toward new technologies, and opinions about artificial intelligence and robots in healthcare. The interviewers interviewed 50 participants, of whom 26 were females. The interview transcriptions were analyzed with MAXQDA Analytics Pro 2022 (Release 22.7.0). An approach based on thematic analysis was employed to evaluate the interviews' content.

RESULTS

Thematic analysis of the interviews resulted in the identification of three main themes: (1) knowledge about e-health, (2) barriers, and (3) facilitators of e-health use. Recognition of the term 'e-health' was limited among study participants, although they used e-health solutions frequently. The main barriers included limited digital skills and unfavorable attitudes to new technologies. Some of the participants complained about technical difficulties, e.g., poor Internet access. The main facilitators identified based on the interviews include saving time and reducing costs, as well as the ability to access medical records in one repository, as in the case of the Internet Patient Account. Some people believed e-health to be an element of progress. Overall, the study participants supported sharing their medical data for research.

CONCLUSIONS

Implementing e-health solutions seems to be perceived as an inevitable consequence of technological progress. However, a lack of adequate technical skills remains one of the major obstacles to efficiently utilizing e-health's potential.

Adoption and perception of prescribable digital health applications (DiGA) and the advancing digitalization among German internal medicine physicians: a cross-sectional survey study

BACKGROUND

Therapeutic digital health applications (DiGAs) are expected to significantly enhance access to evidence-based care. Since 2020, German physicians and psychotherapists have been able to prescribe approved DiGAs, which are reimbursed by statutory health insurance. This study investigates the usage, knowledge and perception of DiGAs as well as the growing digitalization among internal medicine physicians in Germany.

METHODS

A web-based survey was distributed at the 2024 annual congress of the German Society for Internal Medicine. Participants could respond by scanning a QR code or directly on a tablet.

RESULTS

A total of 100 physicians completed the survey, with a mean age of 43.4 years. The majority were internal medicine physicians (85%). Of the respondents, 31% had already prescribed DiGAs, and 29% had tested one. Self-rated knowledge of DiGAs was low (median score 3.17/10). The main barriers identified were lack of knowledge about effective implementation (60%), lack of time for patient onboarding (27%), and concerns about patient adherence (21%). However, 92% believed that DiGAs could improve care, and 88% expressed interest in specific digital health training. The majority (64%) stated that digitalization had a positive impact on medical care and 39% of physicians expected their daily workload to decrease due to digitalization. In addition, 38% believed that the physician-patient relationship would improve as a result of digitalization.

CONCLUSIONS

While physicians widely acknowledged the potential benefits of DiGAs, adoption and understanding remain limited. Specific training in digital health is crucial to accelerate digitalization in internal medicine.

Privacy concerns among the users of a national patient portal: A cross-sectional population survey study

INTRODUCTION

Seeking and receiving care requires disclosure of personal information which is recorded as health data in electronic health records. Thereafter, restricting the flow of information is dependent on data protection, information security, ethical conduct, and law. Privacy concerns may arise as patients' options concerning privacy have been balanced to cater both the privacy of patients and the needs of healthcare, as well as secondary use of data.

METHODS

This study examined privacy concerns among the users of a national patient portal in a representative sample of Finnish adults aged 20 to 99 years old (n = 3,731). We used logistic regression analysis with population weights to seek answers to which factors are associated with privacy concerns. The cross-sectional survey data was collected in 2020.

RESULTS

Every third patient portal user had privacy concerns. Those who were 50 to 59 years old (p = 0.030) had privacy concerns more often than 20 to 49-year-olds. Those who had financial difficulties (p = 0.003) also had privacy concerns more often while those, who had good digital skills (p=<0.026), did not need guidance on telehealth service use (p=<0.001) and found telehealth service use to be beneficial (p = 0.008), had privacy concerns less often.

CONCLUSION

The usefulness of telehealth seems to play an important role in privacy concerns. Another important factor is the skills required to use telehealth services. We encourage providing guidance to those who lack the necessary skills for telehealth service use. We also encourage putting effort not only into data protection and information security measures of telehealth services, but also into providing transparent and comprehensible privacy information for the service users as privacy concerns are common.