Abstract
The parent of an adolescent patient noticed an upcoming appointment in the patient's
portal account that should have remained confidential to the parent. As it turned
out, this parent was directly accessing their child's adolescent patient portal account
instead of using a proxy account. After investigation of this case, it was found that
the adolescent account had been activated with the parent's demographic (i.e., phone/email)
information. This case illustrates the challenges of using adult-centric electronic
health record (EHR) systems and how our institution addressed the problem of incorrect
portal account activations.
Confidentiality is fundamental to providing healthcare to adolescents. To comply with
the 21st Century Cures Act's information blocking rules, confidential information
must be released to adolescent patients when appropriate while also remaining confidential
from their guardians. While complying with this national standard, systems of care
must also account for interstate variability in which services allow for confidential
adolescent consent. Unfortunately, there are high rates of guardian access to adolescent
portal accounts which may lead to unintended disclosure of confidential information.
Therefore, measures must be taken to minimize the risk of inadvertent confidentiality
breaches via adolescent patient portals.
Our institution implemented a guardrail system that checks the adolescent patient's
contact information against the contact information of their parent/guardian/guarantor.
This guardrail reduced the rate of account activation errors after implementation.
However, the guardrail can be bypassed when demographic fields are missing. Thus,
ongoing efforts to create pediatric-appropriate demographic fields, clearly distinguishing
patient from proxy, in the EHR and workflows for registration of proxy accounts in
the patient portal are needed.
Keywords
adolescent confidentiality - patient portal - demographics - electronic health records
