Attitude and Opinion Research eHealth Initiative Work in Support of the Gulf Coast Task Force

1. Attitude and Opinion Research eHealth Initiative Work in Support of the Gulf Coast Task Force

2. Figure 1. Gulf Coast Health Information Task Force

3. Step 1: Develop Initial Key Messages Step 2: Conduct Focus Group Research Step 3: Conduct Quantitative Telephone Research Step 4: Analyze Research Results to Inform Final Key Messages Step 5: Finalize Key Messages for Media/ Education Kit & Dissemination Plan Consumers AL Sample Consumers FL Sample FeHI GulfCoast Team Initial Messages Physicians LA Sample Physicians MS Sample MS Employers/ Purchasers ►Media Outreach Tools ►Shared Graphics ►Tools to Support Marketing Activities ►Tools to Support Partnership Development ►Resources, Research, Real Examples TX Sample Employers/ Purchasers June 2006 July 2006 Aug 2006 Sept-Dec 2006 May 2006 Source: Health2 Resources, 2006

4. An overall summary presentation of the written exercises from six focus groups conducted June 20-22, 2006.

5. Methodology On behalf of E-Health Initiative, Public Opinion Strategies conducted six focus groups among primary care physicians, consumers, and employers in the following locations and dates: • Houston, TX June 20, 2006 • Eight physicians • Nine consumers • Mobile, AL June 21, 2006 • Nine small business owners • Eight consumers • Tampa, FL June 22, 2006 • Eight employee benefits managers in larger companies • Eight physicians

6. Consumers Male and female Registered voters, likely to vote in this year’s election Age 25-74 High school graduate or higher Household income of at least $25,000   Employers Small business owners, 4-50 employees providing at least some portion of health insurance benefits for FTE Age 30-74 with at least some college, personal income of at least $40K women, $60K men Benefit Managers were persons responsible for making decision on health care coverage in business with over 100 employees paying at least some portion of health insurance benefits. In position for at least a year. Same age and income as Small Business. Physicians Mix of internists, general practitioners, OB/GYN's and pediatricians.  Residents and interns were excluded. Audiences Defined

7. Audiences Defined- Continued Respondents in all groups were asked a series of questions about their technology use and attitudes to adopting new technology.  Based on their responses they were categorized as being "tech-savvy" or "not tech-savvy."  There was a mix of "tech savvy" and "not tech-savvy" participants in each group.

8. Describing Your Experience As a group, participants were asked to share exactly what they think is in their medical record*. * Only asked among Consumers and Employers Slide 8

9. What exactly do you think is in your medical record?

10. Technology and Health Care • Participants were asked to write down what the phrase “Health Information Exchange” means to them. • Then they were asked for their reaction to the phrase “Health Information Exchange.” They were asked if they felt positive (thumbs up), negative (thumbs down), or neutral (thumbs sideways) towards the phrase. • Next, as a group, participants brainstormed questions they would like someone to answer about “Health Information Exchange” and what they would like to know more about. Slide 10

11. Please write down what the term “health information exchange” means to you. Consumers “A forum for exchanging information regarding health issues. This could be between patients, patient-physician, physician-physician or pharmaceutical reps to patients.” “A form of medical information storing via different methods, be it courier, Internet or phone.” “I think it is speaking of exchanging of information with other providers, health insurers or other affiliates of the medical field having to do with your health issues.” “Receiving and providing health information (specific details) with someone else, doctor or receiving from the Internet.”

12. Please write down what the term “health information exchange” means to you. Consumers “I think that this term: Health Information Exchange means that in the future your doctor will be able to access your previous health information if you’ve switched practitioners.” Doctors can cross reference past histories, medications, and if all bills were paid by insurance company.” “Transfer of medical records from one doctor’s office to the next. Also information that is sent to insurance company’s, patient to doctor conversations.” “The ability for doctors to exchange information on a patient, to consult other doctors on test results or conditions, symptoms that a patient is having.”

13. Please write down what the term “health information exchange” means to you. Employers “Communication between the patient or participant and the health care provider or administrator of a plan.” “Health information. The exchange of health information via computer, electronically.” “Sharing of patient data with other authorized care providers.” “General health information provided by health insurance carriers on common health conditions and possible treatment options.”

14. Please write down what the term “health information exchange” means to you. Employers “Exchange of information to assist in the best possible healthcare.” “Reporting diagnosis, care, treatment, medications and other health care information to another person or group.” “Health data transferred to and from like EDI (Electronic Data Interchange)” “Being able to share health information between doctors, pharmacy, and insurance companies.” “I don’t know.”

15. Please write down what the term “health information exchange” means to you. “Flow of data between providers and between providers and patients. Payers may also be included in this.” “Transfer of medical information from one place to another or from one provider to another.” “Exchanging health information between other physicians, health care companies, insurance companies, hospitals and patients to allow integrating this information easily.” “The systems used to exchange information between providers and patients in the healthcare system.” “information between doctors, hospitals, different consultants, and labs.” “Conveyance of patient health data to insurance companies, other physicians, schools, home care providers, etc. for clinical or financial reasons.” Physicians

16. Please write down what the term “health information exchange” means to you. Physicians “Electronic transfer of patient data between hospitals and physicians. Physician to physician discussion of patient data. Discussion of patient information to the patients themselves by the physicians.” “Ability to retrieve information on any patient at any time without any restrictions (the anathema of HIPAA).” “Free exchange of patients’ data between individual entities.” “Being able to ascertain health information from patients, other doctors, hospitals, labs, diagnostic centers, in a timely and efficient manner.” “Ability to consolidate all sources of information about a given patient into a central information system, i.e. labs, medical information, medicine, tests, etc.”

17. What’s your reaction to the phrase “Health Information Exchange”… thumbs up/positive, thumbs sideways/no strong feelings one way or the other, or thumbs down/negative?

18. Questions about Health Information Exchange

19. Health Information Exchange • Then participants read a description of health information exchange (on the next slide) and then were asked to rate it on two scales. • They were asked to rate their overall opinion about health information exchange on a scale from 1 to 100, with 1 being very unfavorable and 100 being very favorable. • They were asked how likely they would be to actually USE this service, again, on a scale from 1 to 100 with 1 being not at all likely to 100 being extremely likely to use this service. • After they read the description they were asked as a group what other questions they have about the service. Slide 19

20. Health Information Exchange Description: Health information exchange is a way to electronically move your personal health and medical information through a secure online account between various health care providers. Only with your permission can your medical information be shared through this service. 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. Slide 20 Public Opinion Strategies – E-Health June 2006 Focus Groups

21. Please rate your overall opinion about health information exchange on a scale from 1 to 100, with 1 being very unfavorable and 100 being very favorable. 1 10 20 30 40 50 60 70 80 90 100 Very Unfavorable Neutral Very Favorable Please rate how likely you would be to actually USE this service, again, on a scale from 1 to 100 with 1 being not at all likely to 100 being extremely likely to use this service? 1 10 20 30 40 50 60 70 80 90 100 Not At All Neutral Extremely LikelyLikely

22. Other Questions about Health Information Exchange

23. Messages Participants were handed two sets of messages and were asked to choose the top two messages which gave them the most favorable opinion of health information exchange from each set. They were then asked to circle the top two messages across the two sets from their top four messages selected. We tested the same 15 messages across all three target audiences, with only slight variations in wording to reflect the type of audience. We also tested an additional message only among employers and one only among physicians. All of the messages tested are listed on the following slides by type of respondents. Slide 23

24. Please write down the letter of the TWO messages in each stack which give you the most favorable opinion of health information exchange. Top Four Messages

25. Please circle the top two messages among the four you have listed above. Top Two Messages

26. “A 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.” Message that Resonated Highest With Consumers “S”

27. “A health information exchange allows all of your physicians to share critical health information that may impact decision making for treatment.” Message that Resonated Most With Employers “J”

28. “Patients have difficulty remembering important medical information which may affect the health care they receive. A health information exchange will enable physicians to have the most up-to-date and accurate health information needed in order to properly care for their patients.” Message that Resonated Most with Physicians “K”

29. Focus on: Security; How it works; Patient permission; Who has access; and The benefit to the patients and physicians Overall the research concluded that in talking to physicians, consumers and employers about health information exchange….

30. Participants were asked to re-rate their overall opinion about health information exchange on a scale from 1 to 100, with 1 being very unfavorable and 100 being very favorable, and to re-rate how likely they would be to actually USE this service on a scale from 1 to 100 with 1 being not at all likely to 100 being extremely likely to use this service. They were then asked to write down some reasons they feel they way they do about the exchange. Slide 30

31. Consumers “Very important during/after a natural disaster. In the event of an emergency this would be great if one was alert.” “I think it is a great idea. It would benefit everyone in an emergency situation. There are always risks and problems to work through getting information to the right people and only to those with access.” “I think the HIE would be for the most part a good thing. As long as certain security access guidelines are set up.” “Would be o.k. – favor heavy government regulation  government-controlled. Age-discrimination has not been addressed, will be used by employers to block individuals.” “One reason I feel neutral about HIE is the access ability, who will be able to access my files. Another reason would be just in case of an emergency, would this information be available?” “I’m not so sure other sources like attorneys and insurance companies could access this information also.”

32. Consumers “Seems like a pretty good idea – we need to continue to explore ideas on how to be more open to new technology and efficiency. GOOD LUCK and thanks for getting our input in the process of your planning.” “Great idea, but I don’t think that it would ever come to be in my time.” “I want medical professionals to be able to retrieve my records in an emergency situation.” “Speed of the process and information to the people who need it.” “All my doctors would have access to all of my medical history. In an emergency, ER would have access to my records. HIE would help everyone participating during a disaster.” “Great way for health information to get from doctor to doctor to improve treatment; and for use in emergency (personal, regional, etc.).” “Very important during/after a natural disaster. In the event of an emergency this would be great if one was alert.”

33. In conclusion, participants were asked to write down the one or two things they heard during the group that convinced them of the importance and need for health information exchange. Slide 33

34. Consumers “Health information is available in the event of a health issue/health history.” “Available when needed. Critical decisions would be able to be made with historical information and personal data.” “The one or two things of importance that I heard would be because of the emergency ability and also if my family had a history of let’s say diabetes, I would be able to pick up or read up on the symptoms my mother had.” “information exchange to reduce medical errors. information available during emergency.” “Needing emergency care when you’re sick (be available).” “Travel from state to state, you may need health care information, hurricanes, storms” “Out of town emergency. Disasters and destruction.”

35. Consumers “Disaster Recovery – I do not have a plan for what to do or any records available for portability. Doctors  Doctors’ communication is vital – let’s try to help them so they can help us!” “Duplication of information wasting money; ability to access information myself – Assurance that system would be secure.” “Possible storage of vital (only) medical information for emergency needs.” “When I heard the name I knew what it was going to be and was convinced it was a good thing.” “Me going to an emergency room not in my area or state, etc. and having an authorized person to get important information needed that might assist in saving my life.” “Ability to share through a network.” “Life and death situations. Natural disasters. Cost savings.”

36. Next Steps

37. Step 5: Messages for Media/Education Kit; Refinement of Communication Channels Step 4: Analysis of Research Results and Development of Final Messages Media Outreach Tools Shared Graphics Tools to Support Employer Communications Tools to Support Partnership Development Resources, Real Examples