Adolescent Privacy and the Electronic Health Record - Sharing Clinical Notes While Protecting Adolescent Confidentiality and Maintaining Parental Insight.
Academic Article
Overview
abstract
BACKGROUND: The 21st Century Cures Act mandates sharing electronic health records (EHRs) with patients. Healthcare providers must ensure confidential sharing of medical information with adolescents while maintaining parental insight into adolescent health. Given variability in state laws, provider opinions, EHR systems and technological limitations, consensus on best practices to achieve adolescent clinical note sharing at scale is needed. OBJECTIVES: To identify an effective intervention process to implement adolescent clinical note sharing, including ensuring adolescent portal account registration accuracy, across a large multihospital healthcare system comprising inpatient, emergency, and ambulatory settings. METHODS: A query was built to assess portal account registration accuracy. At a large multihospital healthcare system, 80.0% of 12 to 17-year-old patient portal accounts were classified as inaccurately registered (IR) under a parent or registration accuracy unknown (RAU). To increase accurately registered (AR) accounts, the following interventions were pursued: 1)distribution of standardized portal enrollment training; 2) patient outreach email campaign to re-register 29,599 portal accounts; 3) restriction of access to remaining IR and RAU accounts. Proxy portal configurations were also optimized. Subsequently, adolescent clinical note sharing was implemented. RESULTS: Distribution of standardized training materials decreased IR and increased AR accounts (p=0.0492 & 0.0058, respectively). Our email campaign (response rate: 26.8%) was most effective in decreasing IR and RAU accounts and increasing AR accounts (p<0.002 for all categories). Remaining IR and RAU accounts, 54.6% of adolescent portal accounts, were subsequently restricted. Post-restriction, IR accounts continued declining significantly (p=0.0056). Proxy portal enhancements with interventions deployed increased proxy portal account adoption. CONCLUSIONS: A multi-step intervention process can be utilized to effectively implement adolescent clinical note sharing at a large scale across care settings. Improvements to EHR technology, portal enrollment training, adolescent/proxy portal settings, detection and automation in re-enrollment of inaccurate portal accounts are needed to maintain integrity of adolescent portal access.
