NEJM -- Surveys of Physicians and Electronic Health Information

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 basisfor practice and policy decisions. Sponsored by the NationalCancer Institute, the HINTS program provides data every 2 yearsfrom a nationally representative sample of U.S. adults 18 yearsof age or older.²

We analyzed data across three administrations of HINTS (6149respondents in 2002�2003, 5586 in 2005, and 4092 in 2008)to gain a better understanding of the public's trust in anduse of sources of health information, especially informationfrom physicians, the Internet, and other sources, such as themass media. Three sets of findings are shown in Figure 1. First,despite a decade's worth of exposure to health information onthe Internet, the public's trust in physicians as their preferredsource 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 theywent first for specific disease information (i.e., cancer),respondents reported going to the Internet first — a tendencythat increased over the period of analysis (odds ratio, 1.44;P<0.05). The tendency to rely on sources other than physiciansor the Internet for initial information has diminished (oddsratio, 0.43). Third, when Internet users were asked about theiractivities online, a small but growing number of respondentsindicated that they used e-mail to communicate directly withtheir physicians (odds ratio, 2.51; P<0.05).

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  Figure 1. Patterns in Respondents' Trust in and Use of Sources of Health Information, 2002–2008.

All odds ratios were calculated for the trend between 2002–2003 and 2008. Percentages were weighted according to published procedures for the adjustment of estimates on the basis of complex sampling design.² For each category shown, the comparison between 2002 and 2008 was significant (P<0.05).

 

 
These data on the changes that are being enabled by nationalinvestments in health-information technology indicate that accessinghealth information online does not appear to reduce trust inphysicians, as some observers have feared.³ Trust may actuallybe increasing as consumers rely on their physicians to interpretthe confusing nature of online information.⁴ Nevertheless, consumersstill appear to be taking advantage of the convenience of theInternet as an initial source of disease information, and relianceon information from other sources appears to be falling. Theuse of the Internet as a channel of communication between patientsand their physicians is showing a small but persistent increaseover time. These national survey data should have profound implicationsfor practice and for clinical care, including compensation andworkflow.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 withthe full text of this letter at NEJM.org.

References

 

1. Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009;360:1477-1479. [Free Full Text]
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. Lee CJ. Does the Internet displace health professionals? J Health Commun 2008;13:450-464. [CrossRef][Web of Science][Medline]
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. [Free Full Text]
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]