Using Electronic Health Record Modifications to Increase Use of Adolescent Sensitive Notes

Area of Science:

• Adolescent Medicine
• Health Informatics
• Quality Improvement

Background:

• Adolescent confidentiality is crucial but challenged by the 21st Century Cures Act, granting guardians access to some medical records.
• Pediatric Hospital Medicine (PHM) history and physical (H&P) notes are accessible to guardians, unlike adolescent sensitive notes (ASN).
• This creates a conflict for documenting sensitive adolescent health information, such as sexual history and substance use (SHSU).

Purpose of the Study:

• To decrease the documentation of sexual history and substance use (SHSU) within pediatric H&P notes.
• To improve the confidential handling of sensitive adolescent health information.
• To increase the appropriate use of adolescent sensitive notes (ASN).

Main Methods:

• A quality improvement study involving adolescents aged 13-17 from August 2020 to May 2021.
• Interventions included disappearing help text in PHM H&P templates prompting SHSU placement in ASNs and provider communication.
• Primary outcome: SHSU documentation in H&P notes; Process measure: ASN presence; Balancing measures: other sensitive data in ASNs and encounters without SHSU documentation.

Main Results:

• Documentation of SHSU in H&P notes significantly decreased from 58.4% and 50.4% to 8.4% and 11.4%.
• Utilization of ASNs increased substantially from 22.8% to 72.3%, indicating a shift in documentation practices.
• No significant changes were observed in encounters lacking SHSU documentation or documentation of other unapproved social history domains in ASNs.

Conclusions:

• The disappearing help text intervention effectively reduced SHSU documentation in H&P notes and increased ASN use, thereby enhancing adolescent confidentiality.
• This simple, targeted intervention demonstrates a successful strategy for maintaining patient privacy in pediatric care.
• Further application of disappearing help text in other medical specialties could improve sensitive data management.