Correspondence

Surveys of Physicians and Electronic Health Information

N Engl J Med 2010; 362:859-860March 4, 2010

Article

To the Editor:

The role of electronically accessible health information in clinical care has been the focus of increasing discussion nationally.1 In 2001, we launched the Health Information National Trends Survey (HINTS) to provide an evidentiary basis for practice and policy decisions. Sponsored by the National Cancer Institute, the HINTS program provides data every 2 years from a nationally representative sample of U.S. adults 18 years of age or older.2

We analyzed data across three administrations of HINTS (6149 respondents in 2002–2003, 5586 in 2005, and 4092 in 2008) to gain a better understanding of the public's trust in and use of sources of health information, especially information from physicians, the Internet, and other sources, such as the mass media. Three sets of findings are shown in Figure 1Figure 1Patterns in Respondents' Trust in and Use of Sources of Health Information, 2002–2008.. First, despite a decade's worth of exposure to health information on the Internet, the public's trust in physicians as their preferred source of health information has remained high and, if anything, increased from 2002 to 2008 (odds ratio, 1.29; P<0.05). Conversely, trust in health information from the Internet (odds ratio, 0.74; P<0.05) or from other sources (odds ratio, 0.76; P<0.05) decreased during the same period. Second, when asked where they went first for specific disease information (i.e., cancer), respondents reported going to the Internet first — a tendency that increased over the period of analysis (odds ratio, 1.44; P<0.05). The tendency to rely on sources other than physicians or the Internet for initial information has diminished (odds ratio, 0.43). Third, when Internet users were asked about their activities online, a small but growing number of respondents indicated that they used e-mail to communicate directly with their physicians (odds ratio, 2.51; P<0.05).

These data on the changes that are being enabled by national investments in health-information technology indicate that accessing health information online does not appear to reduce trust in physicians, as some observers have feared.3 Trust may actually be increasing as consumers rely on their physicians to interpret the confusing nature of online information.4 Nevertheless, consumers still appear to be taking advantage of the convenience of the Internet as an initial source of disease information, and reliance on information from other sources appears to be falling. The use of the Internet as a channel of communication between patients and their physicians is showing a small but persistent increase over time. These national survey data should have profound implications for practice and for clinical care, including compensation and workflow.5

Bradford W. Hesse, Ph.D.
Richard P. Moser, Ph.D.
National Cancer Institute, Bethesda, MD
hesseb@mail.nih.gov

Lila J. Rutten, Ph.D., M.P.H.
National Cancer Institute at Frederick, Frederick, MD

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

5 References

1. 1

   Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009;360:1477-1479
   Full Text | Web of Science | Medline

2. 2

   Nelson DE, Kreps GL, Hesse BW, et al. The Health Information National Trends Survey (HINTS): development, design, and dissemination. J Health Commun 2004;9:443-460
   CrossRef | Web of Science | Medline

3. 3

   Lee CJ. Does the Internet displace health professionals? J Health Commun 2008;13:450-464
   CrossRef | Web of Science | Medline

4. 4

   Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med 2005;165:2618-2624
   CrossRef | Web of Science | Medline

5. 5

   Hesse BW, Shneiderman B. eHealth research from the user's perspective. Am J Prev Med 2007;32:Suppl:S97-S103
   CrossRef | Web of Science | Medline

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