Although the Office of The National Coordinator for Health Information Technology’s (ONC) Information Blocking Provision in the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multiuser electronic health record (EHR) access and proxy access, concerns on the potential for harm in adolescent care contexts exist. We describe how the provision could erode patients’ (both adolescent and older patients alike) trust and willingness to seek care. The rule’s preventing harm exception does not apply to situations where the patient is a minor and the health care provider wishes to restrict a parent’s or guardian’s access to the minor’s EHI to avoid violating the minor’s confidentiality and potentially harming patient-clinician trust. This may violate previously developed government principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate “shadow charting” will be burdensome (and prohibitive) for health care providers. Under the privacy exception, patients have the opportunity to request information to not be shared; however, depending on institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot “improperly encourage or induce a patient’s request to block information.” Fearing being found in violation of the information blocking provisions, providers may feel that they are unable to guide patients navigating the release of their EHI in the multiuser or proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations that care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multiuser or proxy access situations.

UNSTRUCTURED While the Office of The National Coordinator for Health Information Technology’s (ONC) Information Blocking Provision of the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multi-user electronic health record (EHR) access and proxy access concerns emerged over the potential for harm in adolescent care contexts. We describe how the provision could erode the trust and the willingness of patients (both adolescent and older patients alike) to seek care. The rules’ preventing harm exception does not apply to situations where the patient is a minor and the healthcare provider wishes to restrict a parent’s or guadian’s access to the minor’s EHI to avoid violating the minor’s confidentiality and potentially harming patient-clinician trust. This may violate government-developed principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate “shadow charting” will be burdensome (and prohibitive) for healthcare providers. Under the privacy exception, patients have the opportunity to request information not be shared; however, depending upon institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot “improperly encourage or induce a patient’s request to block information”. Fearing being found in violation of the information-blocking provisions, providers may feel unable to guide patients navigating releasing their EHI in the multi-use/proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations who care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multi-user/proxy access situations.