Factors affecting patient and public perceptions of the adoption of electronic health record sharing: A Hong Kong study

The disclosure of personal health information in electronic health records (eHR) highlights privacy and security concerns that are complicated by the digitization and interoperability of health records. Hong Kong's Electronic Health Record Sharing System (eHRSS), introduced in March 2016, enables eHR sharing among public and private health services upon the consent of patients. Based on a September 2021 survey, this study examined the specific context of Hong Kong, patient and public perceptions on the security and privacy of eHR sharing, correlation of trust with personal privacy and security concerns, and how perceptions affect health care-related decisions.

Using a random sample of householders aged 45-70 years, the study conducted a questionnaire survey on respondents' awareness, perceived benefits, and obstacles to participating in the eHRSS, and the impact of their perceptions on health care-related decisions. A focus group discussion with 13 participants further explored views on the security of Hong Kong's eHRSS and their readiness to support the system.

The study analyzed data from 400 responses. The findings showed a low degree of awareness of the eHRSS. Privacy and security concerns were impeding factors in the sharing of information; half of the respondents reported being concerned over their personal health information being part of the eHRSS. The majority (86.9%) expressed conditional support for the sharing of information. Despite their concerns on security and privacy, 66.5% and 77.9%, respectively, would not withhold information nor postpone the seeking of medical care based on those concerns. Participants in the focus group expressed concerns regarding eHRSS registration, data leaks, information accuracy, and the potential prejudice that may result in discrimination and inequality in health care provision.

Satisfaction with the health care services played a role in the trust reposed in the Hospital Authority and health care providers and institutions. Security and privacy were decisive factors in respodents' refusal to seek care from physicians who had violated their privacy. Respondents expressed greater interest in sharing their information if measures were in place for anonymization and punishing data misuse. Ensuring rights of control toward information sharing would inspire greater confidence among patients.