Oregon Health Authority Results of a Survey of 250 Urban and 250 Rural Residents in Oregon Grove Insight June, 2011 1

This survey was conducted under the auspices of Oregon's Health Information Technology Oversight Council (HITOC) with funding through the Office of the National Coordinator for Health Information Technology Cooperative Agreement for Health Information Exchange. 2

Methodology A survey of 500 Oregon residents was conducted by telephone using professional interviewers. A voter file was used. 250 interviews were conducted in “urban” counties and 250 interviews were conducted in “rural” counties. Interviews were conducted June 6-9, 2011. The margin of error for the sample as a whole is plus or minus 4.4 percentage points at the 95% level of confidence. The margin of error for subgroups varies and is higher. Throughout this report, we refer to “younger” and “older” residents. Younger residents are those age 49 and under and older residents are those age 50 and older. 3

Regions Survey respondents were divided by region in the following ways: Urban residents: Clackamas, Deschutes, Douglas, Jackson, Lane, Marion, Multnomah, Washington Rural residents: Baker, Benton, Clatsop, Columbia, Coos, Crook, Curry, Gilliam, Grant, Harney, Hood River, Jefferson, Josephine, Klamath, Lake, Lincoln, Linn, Malheur, Morrow, Polk, Sherman, Tillamook, Umatilla, Union, Wallowa, Wasco, Wheeler, Yamhill 4

Views of General Health IT Concepts Grove Insight June, 2011 5

Generally Speaking, Rural Residents Tend to Have More Favorable Impressions of the Items Tested and Have a Greater Awareness of Them Compared to Their Urban Counterparts Favorability Rating Rural 6 Favorability Rating Urban

General Views and Perceptions of Electronic Health Records Grove Insight June, 2011 7

Around Three-Quarters of Urban and Rural Residents Favor Encouraging Medical Providers to Adopt EHRs Favor, strongly 45% Favor, not strongly 30% Undecided There is a national trend encouraging medical providers, like your doctor, to change how they store patients’ private medical records. Medical records include things like medical test results, reports written by your doctors, prescriptions to the pharmacy and what happens to you in the hospital. Instead of using paper copies and forms, medical providers would instead store your medical records on computers —allowing primary care doctors to more easily share your health records with you, with specialists or with other medical providers. There would be built-in security mechanisms to ensure the privacy of your medical records is protected. Having heard this, do you favor or oppose efforts to have your medical records stored and shared electronically? 75% 6% 20% Oppose, strongly 13% Oppose, not strongly 7% 8 Favor, strongly 49% Favor, not strongly 28% Oppose, strongly 13% Oppose, not strongly 6% Undecided Urban Rural 77% 19% 4%

Employers and Younger Residents Tend to Be the Most Likely to Favor Encouraging Medical Providers to Adopt EHRs 9

Oregonians With Access to the Internet Tend to Mirror or Slightly Exceed Overall Support Those With No Internet Access, Though Less Supportive, Still Provide a Majority in Favor of EHRs 10 “No Internet” combined from both samples: 58% favor, 26% oppose

Urban and Rural Residents Place a High Degree of Importance on Having Doctors Start Electronically Storing and Sharing Medical Records Generally speaking, when thinking about health care reform as a whole, how important is the process of having doctors start electronically storing and sharing our medical records—is it very important, somewhat important, not too important or not important at all? If you aren’t sure, you can tell me that, too, and we will move on. Net Important: 71% Net Not Important: 24% 11 Net Important: 74% Net Not Important: 23% Urban Rural

12 If needed, whether for an emergency or routine care, any doctor, specialist or other medical provider you see, would be able to pull up a complete copy of your medical record You would have the ability to access and view your own medical records online You would be able to use the Internet to manage your own healthcare, like accessing and viewing your medical records, scheduling medical appointments, filling prescriptions or emailing your doctor You would be able to use the Internet to update your medical records—such as inputting home blood test results if you are diabetic 47% 54% 45% 45% 44% 44% 37% 39% “Strongly Favor” Urban Rural Ensuring Medical Providers Have Easy Access to a Patient’s Medical Record Is the Most Approved of Aspect of EHRs There Is Little Variation in Support—Urban and Rural Oregonians Offer Wide Margins of Support for Every Aspect of EHRs Tested Net “Favor” in Urban and Rural Areas

Privacy Is the Most Important Aspect of the EHR Effort for Urban and Rural Residents Though Residents Attach a High Level of Importance to Everything Tested Circled issues drive support to the proposal among urban residents, according to analytical modeling 13 Ensuring that your medical records are kept private and confidential Ensuring that no matter where you are, doctors or specialists have access to an up-to-date copy of your medical records Reducing the number of repetitive tests ordered by your doctor or specialist Having all your medical records available in one place rather than having to go from provider to provider to complete the picture Giving you access to your own complete medical record with no additional charge Giving you access to the same information that your health insurance company has Reducing unnecessary administrative costs for things that do not improve your health Being able to order and fill your prescriptions online 64% 72% 52% 62% 53% 56% 53% 57% 46% 53% 46% 48% 42% 49% 39% 41% “Very Imp.” Urban Rural Net “Important” in Urban and Rural Areas Circled issues drive support to the proposal among rural residents, according to analytical modeling

14 Receiving notification when health care providers access your medical records Being able to receive your lab test results online Being able to schedule medical appointments online 50% 42% 34% 32% 42% 40% 32% 30% 35% 35% 41% 31% 40% 31% “Very Imp.” Urban Rural Items of Second Tier Importance Tend to Focus on Some of the More Nitty-Gritty Details of Health Information and Electronic Medical Records Net “Important” in Urban and Rural Areas Being able to view a list of prescriptions online Being able to receive preventative care updates and support online Being able to make specific updates to your medical records online Being able to make specific updates to your family’s medical records online

15 Rural Residents Place More Emphasis on Being Able to Order and Fill Prescriptions Online Than Viewing a List of Available Prescriptions Urban Residents Place Roughly Equal Emphasis on Both Net “Important” in Urban and Rural Areas Being able to view a list of prescriptions online Being able to order and fill your prescriptions online

Your medical records being hacked and stolen by identity thieves 16 Your medical records being stored safely and securely to protect your privacy Your medical record being used to drop you from insurance or to raise your rates Mistakes possibly occurring in your care or treatment because a test or other piece of information was typed into your medical record incorrectly Hospitals and other medical providers failing to follow privacy laws Urban Residents Tend to Be Less Concerned About Potential Issues Regarding EHRs Than Rural Residents Top Tier Concerns for Both Revolve Around Privacy “One of most worried” in Urban and Rural Areas Not having enough nurses and doctors trained to use, update and share your medical records appropriately Your medical record getting in the wrong hands, like your employer The cost of your medical care increasing due to added technological expenses for your medical providers

Messaging Health IT Grove Insight June 2011 17

Message Frame: 18

Filling in the Message Frame for Urban Oregonians 19

Filling in the Message Frame for Rural Oregonians 20

Most important tenet of the proposal for both samples: “Ensuring that your medical records are kept private and confidential.” (Net important urban: 87%; net important rural: 89%) Top concern for urban sample: “Your medical records being stored safely and securely to protect your privacy.” (“One of most worried” 47%) Top concern for rural sample: “Your medical records being hacked and stolen by identify thieves.” (“One of most worried” 60%) Most descriptive negative trait for both samples: “Puts the privacy of our medical records at risk.” (Urban net “well” 36%; rural net “well” 57%). -- THE RESPONSE – “Electronic health records are safer and more private than paper. Instead of being faxed to an office, our medical records would be password protected, encrypted if sent by email to another office, and the software would automatically keep track of anyone who accessed them” (“Very convincing” urban 33%; “very convincing” rural 38%) 21

After Hearing Eight Messages in Support, Oregonians in Rural and Urban Communities Believe EHRs Are the Wave of the Future, Helping Increase Access, Providers Coordinate Care, and Increasing Convenience 22 Circled traits drive support to the proposal among urban residents, according to analytical modeling Circled traits drive support to the proposal among rural residents, according to analytical modeling

The Best Message to Support EHRs Emphasize Preventing Mistakes and Saving Lives and Making the System More Convenient and Efficient 23 Electronic health records save lives. If you have a medical emergency in Pendleton, and your primary care provider is in Medford, your medical records won’t be locked away in an office on the other side of the state. The doctor you see in Pendleton would be able to access your electronic health record and make an informed decision on how to provide the best treatment for you Using technology to help coordinate care will help prevent medical mistakes. For instance, the software used to store our medical history can automatically check for problems whenever a new medication is prescribed and alert our doctor to potential conflicts Electronic health records make medical care more efficient. Doctors can order and pharmacists can fill our prescriptions before we even leave their office, our primary doctor and a specialist can better coordinate our care and our medical tests would be automatically updated Ensuring our medical records are available at the right time at the right place will make the system more convenient and facilitate better, faster access to the care we need Circled messages drive support and opposition to the proposal among urban residents, according to analytical modeling Circled messages drive support and opposition to the proposal among rural residents, according to analytical modeling

Oregonians, Particularly Rural Residents, Are More Likely to Oppose EHRs If They Feel It Jeopardizes Privacy 24 % “very well” Rural Urban 28% 23% 11% 10% 16% 15% 11% 14% 12% 9% 12% 10% Circled traits drive opposition to the proposal among urban residents, according to analytical modeling Circled traits drive opposition to the proposal among rural residents, according to analytical modeling

After Rural Residents Hear Eight Messages in Support of EHRs, There Is Little or No Movement in Either Direction Undecided 25 Sometimes during the course of a survey people change their minds. Let me ask you again: Do you favor or oppose efforts to have your medical records stored and shared electronically? RURAL Oppose Favor +3 -2 - 1

With a Similarly Large Amount of Initial Support, There Is Little Movement in Either Direction Among Urban Residents Undecided 26 Sometimes during the course of a survey people change their minds. Let me ask you again: Do you favor or oppose efforts to have your medical records stored and shared electronically? URBAN Oppose Favor +2 -3 - 0 -

Thank you for letting us be a part of your research team.  Our job is to help you interpret these results to get the outcome you want.  Please don’t hesitate to call if there is anything further we can provide. 27