Daniel P. Lorence

Racial disparities in health information access: resilience of the digital divide

Policy initiatives of the late 1990s were believed to have largely eliminated the information “Digital Divide.” For healthcare consumers, access to information is an essential part of the consumer-centric framework outlined in the recently proposed national health information initiative. This study sought to examine how racial/ethnic characteristics are associated with Internet use and online health information. Using a cross-sectional nationwide study of reported Internet use and information search in 2000 and 2002, we studied a stratified sample of computer users from the Pew Internet & American Life Project surveys. Adjusted estimates of race/ethnicity and income effects on Internet use and search behaviors were derived from generalized estimating equations. Results show wide gaps in the use of computers between Hispanics and Whites (OR = 0.593 [0.440, 0.798]) and between African-Americans and Whites (OR = 0.554 [0.427, 0.720]) in 2000 significantly narrowed in 2002 (OR of Hispanic to white = 1.250 [0.874, 1.789]; OR of African-American to Whites = (0.793 [0.551, 1.141]). Gaps in access to the Internet, however, remained consistent between 2000–2002. Differences in health information seeking between Hispanics and Whites existed in both 2000 and 2002. 56% of White Internet users at some time searched for online health information, whereas 42% of Hispanic Internet users did so in 2000. By 2002, these percentages had increased to 13.4 and 15.8%, respectively. Data highlight the persistence of “Digitally Underserved Groups,” despite recent Divide reduction strategies.

Assessing Health Consumerism on the Web: A Demographic Profile of Information-Seeking Behaviors

The growing diversity of the online health information community is increasingly cited as a limiting factor related to the potential of the Internet as an effective health communication channel and information resource. Public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a “Digital Divide,” presents a like problem specific to health care consumers. Access to information, however, is an essential part of the consumer-centric framework outlined in the recently proposed U.S. National Health Information Infrastructure (NHII) and Health Architecture initiatives. To date little research has been done to differentiate the types of health information sought on the Web by different subgroups, linking user characteristics and health-seeking behaviors. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether a “digitally underserved group” persists in the United States. Such an environment would serve to exclude traditionally underserved groups from the benefits of the planned national heath information infrastructure. This exploratory technology assessment study seeks to differentiate and delineate specific behaviors, or lack of desired behaviors, across targeted health care subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decision-making, consumer-centric health information model.

Web searching for sexual information: an exploratory study

Sexuality on the Internet takes many forms and channels, including chat rooms discussions, accessing Websites or searching Web search engines for sexual materials. The study of Web sexual queries provides insight into sexual-related information-seeking behavior, of value to Web users and providers alike. We qualitatively analyzed 58,027 queries from a log of 1,025,910 Excite Web user queries from 1999. We found that sexual and non-sexual-related queries exhibited differences in session duration, query outcomes, and search term choices. Implications for sexual information seeking and Web systems are discussed.

Group disparities and health information: a study of online access for the underserved.

The Internet is an oft-cited learning resource, useful to consumers who seek to educate themselves on specific technical issues or knowledge-intensive topics. Availability of public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a “Digital Divide”, presents a like problem specific to information for uninsured or under-insured healthcare consumers. Access to information, however, is now an essential part of consumer-centric healthcare management. To date little research has been done to differentiate levels of health information access on the Web by different subgroups, linking online socioeconomic characteristics and health seeking behaviors. This analysis of a landmark Pew Foundation survey seeks to differentiate and delineate information access, or lack of desired access, across targeted, “digitally underserved” subgroups.

Healthcare information systems outsourcing

Information systems (IS) outsourcing is a major decision for health care organizations. Analysis of outsourcing costs and benefits have to be made for the departmental or function-specific application of each system. Limited empirical studies have examined healthcare information managers preferences for IS outsourcing. In this paper we report findings from a national survey of more than 16,000 healthcare information managers in the United States, assessing preferences for outsourcing information systems. This included measures of: (1) IS functions most likely to be outsourced, (2) level of satisfaction with performance of healthcare information management (HIM) tasks, (3) factors influencing IS outsourcing decisions, (4) how a healthcare organizations degree of computerized patient record adoption affects the preference for IS outsourcing, and (5) regional differences in outsourcing policies. Six factors were found to influence managers IS outsourcing decisions, including improved patient care, cost savings, regulations, competition, trained staff availability and space considerations. Implications of the findings for healthcare information management outsourcing are discussed.

Study of education disparities and health information seeking behavior.

This exploratory technology assessment examines how educational characteristics of health information seekers are associated with access to computers, the Internet, and online health information. Specifically, we examine (1) if there exists significant variation across identified health technology user groups regarding access to online health information, and (2) if differences between education levels have narrowed, remained constant, or widened over recent years, following national educational initiatives to narrow the technology gap for low-education user groups. Using a stratified sample from national tracking survey data, we find that recent policy initiatives under national technology access and other programs have demonstrated little effect in narrowing the digital divide for low-education users of web-based technologies.

Incremental adoption of information security in health-care organizations: implications for document management

The incremental adoption of electronic media in U.S. health care has created increased risk of security and privacy violations in provider organizations. Protective regulatory efforts have been proposed to address ineffective security of patient information, with severe noncompliance penalties. Using data from a nationwide survey of health information managers, this study examines how industry-wide knowledge management trends may influence the degree of security program adoption in health-care organizations. Results suggest that significant nonadoption of mandated security measures continues to occur across the health-care industry. Paper-based systems still prevail, and computerized settings tend to have less security measures. Implications for document management and knowledge policy are discussed.

Clinical knowledge management using computerized patient record systems: is the current infrastructure adequate?

The proliferation of technology in health care, spurred by environmental factors encouraging the adoption of computerized patient records (CPRs), has led to a widely held perception of fully computerized patient information systems as the industry norm. To test the validity of this assumption, using data from a national survey of certified health information managers, we examined the CPR technology adoption rates reported by health information managers, assessing variation across practice settings, regions, and organizational types. Results show that significant nonadoption, and regional variation, exists in the implementation of CPRs. Overall, nonuniform diffusion of computerized health information technology was found, despite national mandates that promote and at times require uniform adoption. A significantly greater number of hospital-based patient records were computerized, compared to clinics and other practice settings. Managers were frequently found to maintain duplicate CPRs and paper-based patient record systems, even after the initial implementation period. Nonuniform regional CPR adoption and redundant paper-based systems were found to be a common practice in medical systems, due in part to cultural factors, mistrust of computerized data, and lack of technology training and knowledge.

The Zeitgeist of Online Health Search

BACKGROUND: Health care queries rank among the most frequent topics of information-seeking activity initiated by users of commercial search engines. The quality of information located through existing search engine technology has received little attention, especially when considering the widely varied knowledge levels of internet users. OBJECTIVE: This study sought to create a benchmark technology assessment of online health search trends and practices, with corre-sponding evaluation of its applicability within the Federal Health Architecture (FHA) plan for a nationwide, interoperable health information infrastructure. DESIGN: Exploratory technology assessment, analyzing focus group participants’ views on barriers to effective health information searching, using existing commercial search engine technologies and methods. SETTING AND PARTICIPANTS: Focus group, national leaders in electronic health care (e-health). RESULTS: A variety of web-based assessment tools are available for consumers to be able to identify reliable health websites; however, many may be too difficult for the layperson to use or understand. Existing search technologies are increasingly powerful, although the expanding volume of information on the internet suggests the need for better mediated searching. Search engines provide consumers a means for quickly bypassing information that appears too technical for their individual knowledge level, and at times, searchers often overlook critical information most relevant to their needs. Overall, existing search technologies need to be more interactive, visible, and context-driven, and supported by better technology assessment methodologies, scalability of information, and enhanced access by underserved subgroups. CONCLUSION: Future technology assessments are needed to provide structure for interoperability of health information systems, especially where consumers, providers, and payer systems intersect. State-of-theart search engine technologies are still not widely available to those who can benefit most from them.

Regional Variation in Medical Classification Agreement: Benchmarking the Coding Gap

The growing use of classification and coding of patient data in medical information systems has resulted in increased dependence on the accuracy of coding practices. Information maintained on systems must be trusted by both providers and managers in order to serve as a viable tool for the delivery of healthcare in an evidence-based environment. A national survey of health information managers was employed here to assess observed levels of coder agreement with physician code selections used in classifying patient data. Findings from this survey suggest that, on a national level, the quality of coded data may suffer as a result of disagreement or inconsistent coding within healthcare provider organizations, in an era where physicians are increasingly called upon to enter and classify patient data via computerized medical records. Nineteen percent of respondents report that coder–physician classification disagreement occurred on more than 5% of all patient encounters. In some cases disagreement occurs in 20% or more instances of code selection. This phenomenon occurred to varying degrees across regions and market areas, suggesting a confounding influence when coded data is aggregated for comparative purposes. In an evidence-based healthcare environment, coded data often serves as a representation of clinical performance. Given the increasing complexity of medical information classification systems, reliance on such data may pose a risk for both practitioners and managers without consistent agreement on coding practices and procedures.