Behrooz

ADOPTION OF ELECTRONIC HEALTH RECORDS IN

THE PRESENCE OF PRIVACY CONCERNS: THE
ELABORATION LIKELIHOOD MODEL AND INDIVIDUAL
PERSUASION
Angst and Agarwal, 2009
The main purpose of this study is to empirically investigate whether or not
it is possible to persuade individuals to adopt Electronic Health Records
system, even in the presence of significant levels of privacy concerns. In
other words to test whether providing people with positively framed
messages about the value of EHRs, persuade them to allow their medical
information to be digitized.
By integrating the Elaboration Likelihood Model (ELM) from psychology
with Concern for Information Privacy (CFIP), the authors have tried to
examine the effects of privacy concerns on the modification of attitudes.
Explaining the ELM theoretical basis, the authors clarify that in this study
they focus on the characteristics of message (conceptualized as argument
framing) as well as characteristics of the recipient (conceptualized as issue
involvement) to study how manipulation of these factors influence on
individuals attitudes.
In terms of predicting attitude toward EHR use, based on the ELM theory, it
is hypothesized that the amount of persuasion occurred in an individual (i.e.
post-manipulation attitude) is driven by the argument framing as well as
issue involvement. Also it is hypothesized that the effect of message framing
on post-manipulation attitude is moderated by the individuals issue
involvement as well as CFIP. Moreover, the relation between AF x II
interaction term is hypothesized to be moderated by the concern for
Information Privacy. Also in terms of predicting the likelihood of EHR adoption
by individuals, post-manipulation attitude as well as CFIP are hypothesized to
be the main drivers of likelihood of adoption (i.e. opt-in intention).

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The proposed model is then tested using an experimental approach and by

randomly assigning the subjects to a single treatment with two conditions
(i.e. positive and neutral argument framing). A structural equation modeling
analysis (using a robust maximum likelihood estimation strategy for handling
categorical data) is conducted on data collected from 366 subjects and the
results provide support for all but one hypothesis (i.e. II moderates the
relationship between AF and post-manipulation attitude). At the end, a series
of post-hoc analyses are also conducted to investigate the interactions
among variables.

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Privacy Protection and Technology Diffusion:

The Case of Electronic Medical Records
Miller and Tucker, 2009
The main goal of this paper is to quantitatively examine the role of statelevel privacy protection legislations on the adoption of Electronic Medical
Records (EMRs) by hospitals.
At the first stage, the authors argue that network effects (i.e. the economic
externality

produced

from

one

hospitals

adoption

decision

on

the

profitability of EMR adoption for other hospitals) may shape the adoption of
EMRs. They maintain that whereas privacy protection can increase the
network benefits to hospitals of exchanging information electronically, at the
same time it more expensive infrastructure and thereby can reduce network
benefits. They model the net gain of adoption and discuss that it involves
two components: network benefits and stand-alone benefits.
After describing the data set used in the study (the HADB as well as AHA
survey), it is used to study how network effects shape the adoption of EMRs,
and how these effects differ for states with and without legislations. A linear
probability model is used to examine this issue. The results from both panel
and cross-sectional data sets provide evidence of the presence of network
benefits from EMRs that are diminished by privacy laws. In states without
hospital privacy protection it is shown that one hospitals adoption increases
the propensity of other hospitals in the local area to adopt, while no such
effect has been observed in states with privacy protection.

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The next section deals with examining the effect of passing privacy
protection legislation on adopting EMRs, without studying its effect on the
network benefits of adoption. A negative relationship between privacy
legislations and EMR adoption is reported.
In short, the study indicates that although there may be many reasons for
states to restrict medical providers ability to disclose information, these
restrictions do lead to lower adoptions of EMRs.

The impact of personal dispositions on information

sensitivity, privacy concern and Trust in disclosing
health information online
Bansal et al., 2010
The main goal of this article is to explore the role of personal dispositions
(i.e. personality traits, health status, information sensitivity, and other
personal circumstances) as an intrinsic factor on individuals online trust and
privacy concerns with respect to their decision to disclose their health
information online based on Utility Theory and its application to choice
theory in which consumer preferences depend on personal characteristics.
The authors first argue that disclosing personal health information online is
associated with some potential undesirable outcomes (disutility) as well as
some potential desirable outcomes (utility) and that individuals need to
balance these utilities and disutilities. To investigate this decision, they have
used Utility Theory. Actually they hold that the individuals decision (disclose
vs. not disclose) is a function (unique to each individual) of the benefits and
concerns about this decision. Moreover they mention that these benefits and
concerns, themselves are functions of individuals personal dispositions.
They continue by focusing the disutility part of the mentioned decision
function and argue that privacy concern and trust can be considered as
the main disutility enhancer and disutility reducer factors (respectively) in
this context. Afterwards in the form of a conceptual model, they propose that
personal dispositions influence privacy concern (through perceived
sensitivity of information), which in turn is countered by trust, both affecting
intentions to disclose personal health information.

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The proposed model is then tested with a cross-sectional survey of 367

participants using SEM analysis (mean-adjusted maximum likelihood
criterion). The results provide support for most of the hypothesized
relationships; however the mediated influence of privacy concern on
intention (through trust) is not supported. Moreover, while personality traits
were hypothesized as a main antecedent of privacy concern (through
perceived sensitivity of information), the results indicate that only Emotional
Instability has a significant effect on the perceived sensitivity of information
and the effect of four other personality traits are non-significant. I think this
issue undermines the main contribution of the paper (as contended by
authors) because personality is considered as one of the main components
of personal dispositions in the model.

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Protecting Medical Privacy: Challenges in the Age

of Genetic Information
Alpert, 2003
The main purpose of this paper is to explore some of the privacy issues
with respect to groups genetic information and to propose some courses of
action to deal with these issues in the future.
The paper begins by explaining the concept of informational privacy (i.e.
how much personal information is available from sources other than the
individual to whom it pertains) and the consequences of loss of it as
according to the authors in medical privacy issues, informational privacy is
most often the interest at stake. Particularly they argue that in the context of
genetic information, the loss of informational privacy can lead to intrusion on
group or collectivity (defined as a collective of individuals who are culturally
and ethnically related, where shared characteristics are either likely of
possible) privacy interests. This discussion is then narrowed down to the
specific context of medical information privacy.
In the next section, the use of computers to record, store, and analysis of
medical information is discussed and both benefits and risks are mentioned.
Following that they argue that in United States, one of the complicating

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factors in computerizing medical information is the current federal Law as it

only protects a small proportion of patient information (i.e. substance abuse
and mental health) and they mention that only a few states have adopted
meaningful laws to protect a wider variety of information.
The discussion from the next section is shifted towards the specific context
of Genetic information. First the probabilistic nature of genetic information is
discussed and it is added that new computer chips are able to analyze
human biological samples. Following that the privacy interests of groups
due to genetic analysis and computerized genetic records are addressed
(e.g. the case of Ashkenazi Jews as an interesting group for biological studies
and their consequent concerns about their group privacy). The authors argue
that overgeneralizations in a genetic context may cause group members feel
violated. It is also the case for Family Genetic Information where some similar
privacy issues may arise by conducting genetic tests.
At the end, a number of recommendations are made to help practitioners
as well as policymakers address the genetic information privacy issues in the
future.