Conduct Focus Groups to Test Messages and Materials

Attachment D4

Moderator’s Guide for Health Professional (Nurses & PA’s) Focus Groups

Electronic Health Records and Health IT

Need in the room: Pencils and highlighters for all participants. Flip chart for moderator.

Introduction [10 minutes]

Welcome and thank you for joining us. My name is [moderator’s name] and I will be your moderator for this focus group session, which is about electronic health records and health information technology (health IT). I’d like to hear how you feel about issues related to this topic, and I’m also interested in your perceptions of some messages and materials written about this topic. I want to let you know that I am not an expert in this topic, rather I am an independent moderator trained to facilitate our discussion. Our client for this research is the U.S. Department of Health and Human Services, located in Washington, D.C. Our discussion should take about an hour and a half.

Disclosure

• Observation: There is a one-way mirror with observers in the next room who are interested in hearing your views, but don’t want to interrupt the conversation.

• Audio taping and video recording: This session will be recorded by audio and video tape to enable us to capture everything that is being said today. We will use the tape to write our report to our client.

• Confidentiality assured: All of your answers will be confidential, so feel free to say exactly what is on your mind. Nothing will be attributed to any particular person in our report. After we have written a report about all the opinions we have heard here and in other locations, the tapes and notes will be destroyed. Your name or any other personal information will not appear in the report.

Ground rules

• Need to hear from everyone, one at a time please.

• No right or wrong answers, want personal opinions.

• Moderator is impartial, please be candid and honest – tell us how you really feel.

• It’s okay to be critical; if you dislike something you hear, it’s fine to disagree but please be willing to offer your own views and opinions.

• If anyone needs to use the rest room, they are located [specify]. There is no need to stop the discussion.

Do you have any questions before we get started?

Participant introductions

• Brief introductions around the table – specialty, type of practice

Perceptions of Health IT and Communication with Patients (20 minutes)

• Does your practice use health IT, such as electronic health records and health information exchange?

  • [If yes,]

    • What has been your experience with health IT?

      • Do you like it or dislike it? What makes you say that?

    • To what degree do you use it? (Probe: complete or partial conversion to EHRs? Use of health information exchange?]

    • What prompted you to adopt health IT?

  • [If no,] What are some of the reasons why you haven’t adopted health IT?

    • Can you think of any types of benefits, information or services that would make you more likely to adopt health IT?

      • [Probe if necessary:]

        • Information about what type of system to buy

        • A service to help you get your system up and running

        • Staff training services

        • Outcomes data about the value of EHRs and other health IT

        • Counsel/advice about achieving meaningful use and receiving incentives

• Do you have any concerns about the privacy and security of electronic health records and/or health information exchange? Please describe them.

  • How comfortable are you with the security system that other healthcare service providers and payment systems have in place to protect EHRs?

  • How concerned are you that you can ensure that your patients’ health records are kept secure and private?

  • How concerned are your patients about the privacy and security of their EHRs?

  • Thinking about your patients, what are some of their concerns about the security of their HIT and EHRs? [PROBE: Privacy and security problems, use/sale of EHR for research and/or marketing, discrimination from employers/insurers/programs, power outages or natural disasters]

  • Have you experienced any bad outcomes as a result of a breach in the privacy of a patient’s EHR? What happened? Or what have you heard can happen if individuals’ EHR is inappropriately shared and misused?

  • If a patient suffered from a breach in confidentiality and the misuse of their EHR, what recourse or remedy do you think is available to them?

  • What would make you feel more confident about the privacy and security of EHRs? (probe as necessary: certification, peer recommendation, vendor checklist, etc.)

• Do you or does someone in your practice currently talk with patients about the privacy and security of their health information?

  • [If yes:] What do you typically cover in your talks with patients?

• How feasible do you think it is in your practice to have this type of communication with patients?

  • Is it easy or difficult to do? What makes it difficult to do this?

• Would you consider doing this in your practice? How likely are you to do this?

• Do you think patients would find it helpful or not?

• Can you think of any materials or resources that would help you facilitate this type of communication?

Message Testing (20 minutes)

A series of messages has been developed to explain some of the information we’ve discussed. These messages may be used in brochures, web sites, educational materials and other materials. I’d like to get your reactions to these messages. We’ll go through three separate messages.

[Hand out one page containing the three messages]

[For each message, ask:]

• How would you sum up your first impression of this message?

  • Do you like it? Not like it? What makes you say that?

• What are the main ideas this message is trying to get across?

  • How well do you think the main ideas come across in this message?

• Does this message prompt you to take an action?

  • What action does the message prompt you to take?

• Is there anything confusing, unclear or hard to understand?

• Is there anything you want to know that this message does not tell you?

• Is this message believable, or not?

  • Why or why not?

  • What additional information would you need to more strongly believe this message?

• Is this message appealing?

  • What makes the message appealing or unappealing?

  • What would make it more appealing?

• If you wanted to tell a colleague this information in a way that would make it memorable, how would you say it?

Materials Testing (35 minutes)

Several documents have been developed to explain information relating to the adoption of health IT. These documents will be made available to health professionals on government web sites and through partnering organizations. I’d like to get your reactions to these documents. We’ll go through two separate documents.

[Hand out two documents on health IT adoption and/or privacy and security of EHRs]

Please take a few minutes to read the first document…

[For each document, ask:]

• How would you sum up your first impression of this document?

  • Do you like it? Not like it? What makes you say that?

• What are the main ideas this document is trying to get across?

  • How well do you think the main ideas come across in this document?

• Does this message prompt you to take an action?

  • What action does the message prompt you to take?

• Is there anything confusing, unclear or hard to understand in this document?

• Is there anything you want to know that this document does not tell you?

• Is this document believable, or not?

  • Why or why not?

  • What additional information would you need to more strongly believe this message?

• Is this document appealing?

  • What makes the message appealing or unappealing?

  • Is there anything that would make it more appealing?

• There is a visual identity [or logo] at the top of this document – how would you sum up your first impression of the visual identity?

  • Is it clear or unclear which agency has created this document?

  • Does the visual identity make the document more credible to you?

    • Does it reassure you that you can trust the information?

Sources and Channels (3 minutes)

• Where would these messages and materials need to be so that you would pay attention to them?

• Is or would your professional association be a trusted source for this information?

• What other sources would you trust for this information?

  • Are there specific media outlets, online sites or organizations that would be credible to you?

Wrap Up (2 minutes)

• Have your opinions or attitudes about electronic health records and health IT changed as a result of this session?

  • If so, how would you describe the change?

On behalf of HHS, I want to thank all of you for your input today.

• Check with clients for additional questions.

• Collect all materials.