Creating a Guardrail System to Ensure Appropriate Activation of Adolescent Portal Accounts

Abstract

Case Presentation: 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 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. Background: 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. Therefore, measures must be taken to minimize the risk of inadvertent confidentiality breaches via adolescent patient portals. Solutions and Lessons Learned: 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 in the EHR and workflows for registration of proxy accounts in the patient portal are needed.

Shifting into Action: from Data Segmentation to Equitable Interoperability for Adolescents (and Everyone Else)

“…These additional ambiguities and scenarios regarding adolescent rights necessitate further refinement and implementation by health care systems. 59…”

Electronic Health Record Adolescent Confidentiality in a Safety Net Setting

“…[8][9][10]20 These findings signal a significant gap between intention -maintaining adolescent confidentiality that adheres to state laws -and practice. While other institutions have also instituted EHR changes around adolescent confidentiality in response to the 21CCA, [8][9][10]16 our phased approach to safeguard confidentiality while also supporting guardian needs to facilitate care in an urban safety net setting demonstrates feasibility of implementation with relatively fewer information systems resources and among a diverse patient population. 820 Although our overall percentage of adolescents with portal accounts is higher than others reported in the literature, 21 it supports the applicability and necessity of confidentiality safeguards This article is protected by copyright.…”

“…While this does not fully prevent direct guardian use of adolescent accounts, a similar rule has previously been shown to decrease portal activation by guardians. 16 Phase 2: Revising adolescent and proxy account settings. We held focus groups with families and pediatricians and surveyed other local organizations that care for adolescents.…”

Patient Portal Privacy: Perspectives of Adolescents and Emerging Adults Living with HIV and the Parental/Guardian Role in Supporting Their Care

“…On a programmatic scale, interventions that flag and intervene on accounts with matching parent and patient email or phone information may also reduce frequency of parents/guardians registered as their children. 28,29…”