Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight

Area of Science:

• Health Informatics
• Patient Engagement
• Adolescent Health

Background:

• The 21st Century Cures Act mandates electronic health record (EHR) sharing with patients.
• Healthcare providers face challenges in balancing adolescent confidentiality with parental insight into health information.
• Variability in laws, opinions, systems, and technology necessitates best practices for adolescent clinical note sharing.

Purpose of the Study:

• To identify an effective intervention process for implementing adolescent clinical note sharing.
• To ensure accurate adolescent patient portal account registration across diverse healthcare settings (inpatient, emergency, ambulatory).

Main Methods:

• A query assessed patient portal account registration accuracy for adolescents aged 12-17.
• Interventions included standardized training, an email outreach campaign for re-registration, and restriction of inaccurately registered accounts.
• Proxy portal configurations were optimized to support the implementation.

Main Results:

• Standardized training improved registration accuracy (p=0.0492) and increased accurately registered accounts (p=0.0058).
• The email campaign significantly decreased inaccurately registered (IR) and registration accuracy unknown (RAU) accounts, increasing accurately registered (AR) accounts (p<0.002).
• Post-restriction, IR accounts continued to decline significantly (p=0.0056), and proxy portal enhancements increased adoption.

Conclusions:

• A multistep intervention process can effectively implement adolescent clinical note sharing at scale.
• Improvements in EHR technology, training, portal settings, and automated re-enrollment are crucial for maintaining adolescent portal access integrity.