New methods should be adopted to encourage EHR adoption

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Framing communication to emphasize the personal benefits of EHRs to users is likely to increase their purchase and use by early adopters of technological innovations, according to a new study to be published in an upcoming issue of Health Communication.

Slow diffusion of patient-managed EHRs has limited the development of an interoperable health information infrastructure that will greatly improve healthcare quality and cost and will save lives, according to Arun Vishwanath, PhD, and colleagues at the University at Buffalo (UB) in New York. For that reason, increasing EHR diffusion has been called a top priority by the Department of Health and Human Services, the Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Medicaid Services.

Vishwanath and colleagues found that later adopters are greatly influenced to purchase and use such systems by communications that emphasize the benefit of the technology to the collective society.

The study findings are important because electronic information sharing systems promote a greater awareness in patients of changes in their health conditions, said Vishwanath, assistant professor in the department of communication at UB.

EHR programs are structured in the same basic way a consumer credit report is structured, in that consumers may obtain an EHR from various sponsoring organizations. Some EHRs are marketed directly to the consumer by the product vendor. The systems allow for traditional data storage within a consumer-controlled portal through which doctors, clinics and hospitals can, with patient permission, also view the EHR and communicate information and test results back to the patient.

The American College of Medical Informatics said use of EHRs is low because patients resist using and paying for the devices. Although companies Microsoft, Intel and Google are venturing into the market, Vishwanath said, “EHR penetration remains dismal because, like the general public, physicians resist the technology.”

“First is that policymakers and technology implementers should be conscious about communicating the value or usefulness of a new technology to its end users,” Vishwanath said.

“Second, framing is a cost-effective and easily implemented intervention,” he said, “and unlike traditional marketer-dominated advertising and promotion, any high-credibility information source can frame a relevant message using a multitude of media vehicles.”

“Third, the framing effect is not limited to consumers alone. Other stakeholders, such as physicians, who presently see no direct benefits from the PHR, might be persuaded to share the costs through a communication program aimed at emphasizing its benefit to them,” he said.

Finally, Vishwanath concluded that change agents and policymakers need to constantly scan the media and track how the EHR is being presented on various media outlets like blogs and other interactive new outlets and attend to negative information presented there. Negative signs, the researchers wrote, will have an enduring effect on the early adopter's beliefs and such beliefs could spread to later adopters through interpersonal contacts.

Today's EHR systems are in their infancy, Vishwanath said, but a health communication system that integrates EHRs would become a conduit for improved sharing and transfer of medical records and would increase accurate and clear communication between patients and healthcare providers.

“The study and its findings with regard to framing can be applied to other health IT issues besides promoting adoption of PHRs and EHRs,” Vishwanath said, including ERx, or electronic prescribing systems.