With more Americans owning mobile devices than ever before and increasingly using them for health purposes, there are new opportunities to deliver health information to hard-to-reach or underserved populations. “Health information exchange (HIE) between healthcare professionals and patients is occurring more frequently across all ages, races, and ethnicity, allowing for better communication between these individuals,” explains Katrina J. Serrano, PhD. Some reports suggest that mobile technologies could be a solution to the growing demand for electronic HIE and may be a promising strategy for cancer prevention and control.

“Most studies examining HIE have been primarily been internet based, but little attention has been paid to providing health information via mobile devices for underserved populations,” Dr. Serrano says. However, some small investigations suggest that patients may prefer using mobile technology to communicate with healthcare professionals if they are familiar with the technology and trust that their providers will use it to engage in HIE.

Examining Willingness to Engage

For a study published in Annals of Family Medicine, Dr. Serrano and colleagues analyzed data from a national survey to examine differences in patients’ willingness to engage in mobile HIE with clinicians based on the type of information being exchanged. The study also looked at whether or not various factors, such as sociodemographics and trust in professionals, were associated with patients being willing to use mobile devices to exchange different types of health information. In total, data was collected on 3,165 patients using information that was captured in the 2013 Health Information National Trends Survey.

“Our results showed that participants were very willing to use mobile devices to exchange information on appointment and medication reminders, general health tips, and laboratory and test results as well as information on lifestyle behaviors and symptoms as compared with diagnostic information,” says Dr. Serrano (Table below). Only 15% were not at all willing to exchange appointment reminders. Overall, 44% and 40% of respondents were not at all willing to exchange diagnostic information or digital images, respectively. Dr. Serrano says it is possible that willingness to engage in mobile HIE may be determined by the sensitivity or complexity of the information being communicated.


The analysis also revealed the older adults were less likely to be willing to exchange any type of information using mobile devices. Several factors were shown to correlate with a willingness to exchange certain types of information, including education level, income, and trust in healthcare professional information. “The variability in willingness to engage in mobile HIE was mostly related to socioeconomic status,” Dr. Serrano says. Having less than a college education was also associated with lower willingness to use mobile devices to communicate with healthcare professionals about health information across the board.

Notably, only about 6% of the study participants had actually exchanged health information with their mobile devices, but willingness rates were much higher despite these low rates, with well over half reporting that they were willing to exchange certain types of information. “Familiarity with mobile health technology, health literacy, and how well patients are engaged and/or activated in their care may play a role,” says Dr. Serrano. Research suggests that more educated individuals tend to have higher health literacy and also greater levels of patient engagement/activation.

Assessing the Implications

Dr. Serrano says the study findings offer insights on patient preferences toward mobile HIE and factors that contribute to a willingness to exchange health information using mobile technology. “It’s important to recognize that both information type and education level should be considered when developing and tailoring mobile HIE interventions,” she says. “It’s possible that less educated patients are more skeptical of engaging in mobile HIE. Such individuals may need to be made aware of its benefits and efficiencies, such as the ability to track and monitor their own health.”

More Research Required

According to Dr. Serrano, more in-depth research is needed to determine whether the sensitivity or complexity of the health information—or both—are significant factors when considering patients’ willingness to use mobile technology to exchange various types of information. “We need analyses that look deeper into the relationship between age and differences in perceptions regarding technology use and mobile HIE,” she says.

Dr. Serrano adds that researchers should further explore the role of health literacy, patient engagement, and mobile HIE as well as specific constructs of patients’ trust in physicians and mobile HIE. “As this data emerges,” she says, “there is hope that more patients will view HIE with mobile technologies as a helpful strategy to enhance patient care and perhaps improve outcomes.”

Katrina J. Serrano, PhD, has indicated to Physician’s Weekly that she has or has had no financial interests to report.


Serrano KJ, Yu M, Riley WT, et al. Willingness to exchange health information via mobile devices: findings from a population-based survey. Ann Fam Med. 2016;14:34-40. Available at: http://www.annfammed.org/content/14/1/34.abstract.

Panayi ND, Mars MM, Burd R. The promise of digital (mobile) health in cancer prevention and treatment. Future Oncol. 2013;9:613-617.

Dhopeshwarkar RV, Kern LM, O’Donnell HC, Edwards AM, Kaushal R. Health care consumers’ preferences around health information exchange. Ann Fam Med. 2012;10:428-434.

Dimitropoulos L, Patel V, Scheffler SA, Posnack S. Public attitudes toward health information exchange: perceived benefits and concerns. Am J Manag Care. 2011;17:SP111-SP116.

Atienza AA, Zarcadoolas C, Vaughon W, et al. Consumer attitudes and perceptions on mhealth privacy and security: findings from a mixed-methods study. J Health Commun. 2015;20:673-679.