Attitude and Opinion Research- Media/Education Kit

1. 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

2. Figure 1. Gulf Coast Health Information Task Force

3. 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).

4. Step 1: Develop Initial Key Messages Step 2: Conduct Focus Group Research Step 3: Conduct Research Through Telephone Survey 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

5. 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. WHY WE TOOK THESE STEPS AND WHAT THE RESEARCH WAS DESIGNED TO MEASURE:

6. 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 Health2 Resources

7. 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. About Public Opinion Strategies

8. 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

9. 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

10. 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

13. 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/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. 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

15. Who feels most positively and negatively about secure electronic health information exchange? Most Positive (23%): Most Negative (30%) • 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

16. 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)

17. Looking at what adults in the Gulf States already believe is happening related to their own health information: Question: Answer: How likely is it that your doctor’s medical records have a back-up copy offsite? 71% Likely 22% Not Likely (Among the 82% who have a personal doctor)

18. 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)

19. 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

20. Language makes a difference. Where We Started: Where We Are Now: 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.

21. 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.

22. 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?

23. 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% 24% 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?

24. 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

25. 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

26. 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

27. 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 doctor’s handwriting. Slide 27 Public Opinion Strategies – eHealth Initiative July 2006

28. 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?

29. 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

30. 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?

31. 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

32. 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?

33. 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

34. 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 patient’s 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

36. Where we started: What Works: 1) 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. 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.

38. 70 64 48 48% 36% 12% Initial Informed Final 80-100 Mean 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.

39. 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

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

42. TAKE AWAY POINTS Slide 42

43. 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@pos.org Vice President liz@pos.org Slide 43