Attitude and Opinion Research MediaEducation Kit

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Attitude and Opinion Research-Media/Education Kit

• Work in support of the Gulf Coast
• Health Information Task Force
• Katherine H. Capps
• Health2 Resources
• For eHealth Initiative
• September18, 2006

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Figure 1. Gulf Coast Health Information Task Force
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• 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
• 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).

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Step 2 Conduct Focus Group Research
Step 3 Conduct Research Through Telephone Survey
Step 1 Develop Initial Key Messages
Step 4 Analyze Research Results to Inform Final
Key Messages
Step 5 Media/ Education Kit - Dissemination Plan
Consumers
AL Sample
Consumers
FL Sample
FeHI GulfCoast Team Initial Messages
Physicians
TX Sample
Physicians
MS
MS Sample
Employers/ Purchasers
?Media Outreach Tools ?Shared Graphics ?Tools to
Support Education ?Tools to Support Partnership
Development ?Resources, Research, Real Examples

Employers/ Purchasers
LA Sample
June 2006
July-Aug 2006
Aug 2006
Sept-Dec 2006
May 2006
Source Health2 Resources, 2006
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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.

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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

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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.

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Presentation of key findings from the research
conducted in the Gulf States on behalf of eHealth
Initiative.
06700
Bill McInturff, Partner
Elizabeth Harrington, Vice President
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What We Did

• 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
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Overall Goals Of This Research

• 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
11
Understanding public perception and attitudes
about health information exchange in the Gulf
States
Slide 11
12
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
Mean Scores
Total 48 AL 46 FL 49 LA 49 MS 45 TX 49
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
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Verbatim Responses
There remains some confusion with respect to the
meaning of the phrase secure electronic health
information exchange.

• 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/in
  surance 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.

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?
Slide 13
Public Opinion Strategies eHealth Initiative
July 2006
14
Verbatim Responses
When asked to explain why respondents rated the
term secure electronic health information
exchange what they did

• 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
Public Opinion Strategies eHealth Initiative
July 2006
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Who feels most positively and negatively about
secure electronic health information exchange?
Most Negative (30)
Most Positive (23)

• 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

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Looking at what adults in the Gulf States already
believe is happening related to their own health
information
Question
Answer
How does your doctor keep your medical records?
48
29
16

(Among the 82 who have a personal doctor)
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Looking at what adults in the Gulf States already
believe is happening related to their own health
information
Answer
Question
How likely is it that your doctors medical
records have a back-up copy offsite?
71
Likely
22
Not Likely
(Among the 82 who have a personal doctor)
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Looking at what adults in the Gulf States already
believe is happening related to their own health
information
Answer
Question
Is the back-up copy kept
30
54
10

(Among those who believe their doctors have a
back-up offsite)
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Exploring attitudes, opinions and barriers to the
development of health information exchange in the
Gulf States
Slide 19
Public Opinion Strategies eHealth Initiative
July 2006
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Language makes a difference.
Where We Started
Where We Are Now
Health information exchange is a way to
electronically move a patients personal health
and medical information through a secure online
account between various health care providers.
Only with a patients permission can their
medical information be shared through this
service. Health information exchange allows you
to make sure a patients 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.
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Respondents overall impression of health
information exchange becomes significantly more
positive when presented with a brief definition
of the term.
Feelings About Secure Electronic Health
Information Exchange
Mean Score By State
64
48
36
12
Initial
Informed
80-100
Mean
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.
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Support is extremely strong in the Gulf States
for the creation of secure electronic health
information exchange as described.
Support For The Creation Secure Electronic Health
Information Exchange
49 47 42 57 53 48
38
36
37
44
40
32
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?
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Support for the creation of secure electronic
health information exchange is strong across
party as described.
Support For The Creation Secure Electronic Health
Information Exchange By Party
46 63 43 53 47
78
73
69
69
67
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23
22
20
15
36
40
37
39
38
Strong
Soft
Independents
Soft
Strong
Republicans
Republicans
(19)
Democrats
Democrats
(22)
(14)
(16)
(23)
Strongly Favor
Total Favor
Total Oppose
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?
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Verbatim Responses
FAVOR (70)/51 OR HIGHER (58)

• 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
Public Opinion Strategies eHealth Initiative
July 2006
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Verbatim Responses
OPPOSE (21)/ 50 OR BELOW (40)

• 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
Public Opinion Strategies eHealth Initiative
July 2006
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• 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).

Slide 26
Public Opinion Strategies eHealth Initiative
July 2006
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Verbatim Responses

• 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 doctors handwriting.

Slide 27
Public Opinion Strategies eHealth Initiative
July 2006
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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.
Extremely/ Very Confident
Not Too/ Not At All Confident
Total 11 57 AL 12 61 FL 10 57 LA 12 54 MS
10 57 TX 9 57
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?
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Verbatim Responses

• 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
Public Opinion Strategies eHealth Initiative
July 2006
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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.
Doctors.
Trust Most To Provide Information About Secure
Electronic Health Information Exchange
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?
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Determining what language and messaging are most
effective in gaining support for secure
electronic health information exchange
Slide 31
Public Opinion Strategies eHealth Initiative
July 2006
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Having access in an emergency medical situation
is clearly seen as the most important reason to
have secure electronic health information
exchange.
Having access in an emergency medical situation
Having access to your medical record when you are
out of state
Having access in an emergency medical situation
by state
Having access to your medical history when you
visit your doctor
AL 45 FL 48 LA 42 MS 50 TX 44
Having access during or after natural disasters
Transferring lab results, reports or x-rays
between health care providers
Having access to your medication history when you
want to refill your prescriptions
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?
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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
Public Opinion Strategies eHealth Initiative
July 2006
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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.
63
Secure electronic health information exchange
will allow physicians to access the right medical
information at the right time. In an emergency,
getting a patients medical records quickly could
mean the difference between life and death.
Very Convincing
91
Total Convincing
35
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
Public Opinion Strategies eHealth Initiative
July 2006
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What Works
Where we started
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.
1)
2)
61
89
Very Convincing
Total Convincing
37

• 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.

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The messages work to give respondents an even
more positive impression of secure electronic
health information exchange.
Feelings About 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.
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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.
Support For the Creation Secure Health
Information Exchange
38 Strongly
49 Strongly
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?
40
Verbatim Responses
MOVE TO MORE POSITIVE (64)/FAVOR (12)

• 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
Public Opinion Strategies eHealth Initiative
July 2006
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Verbatim Responses
MOVE MORE NEGATIVE (16)/OPPOSE (3)

• Still have concerns about security/privacy/confide
  ntiality
• 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
Public Opinion Strategies eHealth Initiative
July 2006
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TAKE AWAY POINTS
Slide 42
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Gulf States Research
July 2006
Turning Questions into Answers
Washington Denver Los Angeles
www.pos.org ? 703-836-7655
Elizabeth Harrington
Bill McInturff
Partner bill_at_pos.org
Vice President liz_at_pos.org
Slide 43