Influence of Disease-Related Stigma on Patients’ Decisions to Upload Medical Reports to the German Electronic Health Record: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German healthcare system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems perspective, the successful implementation of the EHR largely depends on the patient. In a recent survey, three out of four Germans stated that they intend to use the EHR, but other studies show that intention to use a technology is not a reliable and sufficient predictor of actual use. OBJECTIVE Controlling for patients’ intention to use the EHR, we investigate whether disease-specific risk perceptions related to the time course of the disease and disease-related stigma explain additional variance in patients’ decisions to upload medical reports to the EHR. METHODS In an online user study, each of N=241 German participants were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs. low) and time course (acute vs. chronic) and to decide whether to upload it to the EHR. RESULTS Whereas disease-related stigma (OR 0.154; P<.001) offset the generally positive relationship between intention to use and the upload decision (OR 2.628; P<.001), time course showed no effect. CONCLUSIONS Even if patients generally intend to use the EHR, risk perceptions, for example, related to diseases that are associated with social stigma, may deter people from uploading related medical reports to the EHR. To ensure reliable use of this key technology in digitalized healthcare system, transparent and easy-to-comprehend information about the safety standards of the EHR are warranted across the board, even for populations that are generally in favor of using the EHR

Disease Characteristics Influence the Privacy Calculus to adopt Electronic Health Records: A randomized controlled trial in Germany

“…An important finding is that the intention to use the EHR is significantly influenced by the time course of diseases but not the stigmatization potential, which has been shown to influence actual uploading behavior. 16,17…”

“…multimorbid versus previously healthy patients). 16,17 Whereas for multimorbid patients suffering from various acute and chronic diseases both the time course and the stigmatization potential of a disease had an influence on the decision to upload medical reports to the EHR, 16 previously healthy patients changed their uploading behavior only for diseases with stigmatization potential. 17 Hence, in this article, we examine the influence of both factors on the intention to use the EHR to help better understand user interaction with this central digital health technology.…”

“…An important finding is that the intention to use the EHR is significantly influenced by the time course of diseases but not the stigmatization potential, which has been shown to influence actual uploading behavior. 16,17 For acute diseases, the intention to use EHR is primarily influenced by the perceived benefits (path coefficient=0.471) and social approval (path coefficient=0.178). In the case of chronic diseases, the situation is more complex.…”

“…In previous studies, we and others (a) have adapted the privacy calculus model to understand privacy concerns and intentions to use a technology in the healthcare domain 10,14,15 and (b) have shown that the decisions to upload a medical report in the EHR are influenced by certain characteristics of the health data to be stored in the EHR, such as the time course and potential for stigmatization associated with the disease mentioned on a medical report. 7,[16][17][18] But and whether and how disease and user-specific characteristics influence the privacy calculus and the intention to use the EHR remains an open question.…”