Impact of Adolescent Deactivation Policy on Patient Portal Access

Patient portals can support adolescent engagement and autonomy in their health care, but institutional policies may unintentionally create barriers to use. This study evaluated how automatic patient portal deactivation at age of 13 years, which requires re-enrollment, influences portal access and reactivation among adolescents and their guardians.

We conducted a retrospective longitudinal cohort study of patients who enrolled in the patient portal before age of 13 years and had outpatient encounters between ages of 13 and 17 years at a large academic children's hospital and its affiliated ambulatory clinics. The primary outcome was time to patient portal reactivation after automatic proxy deactivation on the patient's 13th birthday. We compared patient characteristics by reactivation status and used a multivariable Cox proportional hazards model to assess demographic and clinical factors associated with reactivation.

We observed 21,443 patients whose proxy accounts were deactivated and eligible for reactivation. Overall, 13,474 (62.8%) reactivated their portal account. Accounts of patients with chronic conditions reactivated 43% more quickly than those without chronic conditions (HR [95% confidence interval, CI], 1.43 [1.38-1.49]). Accounts of patients who were White and English-speaking reactivated more quickly than those who were Black (HR [95% CI], 0.78 [0.74-0.81]) or Spanish-speaking (HR [95% CI], 0.44 [0.38-0.50]). Patients whose accounts were never reactivated continued receiving care at our organization, averaging appointments on 4.6 days after turning 13 years.

Automatic portal deactivation at age of 13 years reduced patient portal access among adolescent patients. These findings underscore the need for tailored access policies that balance privacy, parental involvement, and digital engagement with the health-care system.