Patient portals for the adolescent and young adult population: Benefits, risks and guidance for use

Lee, Jennifer A.; Holland-Hall, Cynthia

doi:10.1016/j.cppeds.2021.101101

Cited by 16 publications

(13 citation statements)

References 44 publications

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“…A specific consideration for children and adolescents of the age of assent is information privacy and ability to determine and limit access by a proxy (caregiver), for issues that are protected by state and federal law. Lastly, telehealth is a valuable tool for educating trainees as well as patients and caregivers 71 …”

Section: Additional Applications Of Telehealth In Pediatric Emergency...mentioning

confidence: 99%

The role of telehealth in pediatric emergency care

et al. 2023

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In 2006, the Institute of Medicine published a report titled “Emergency Care for Children: Growing Pains,” in which it described pediatric emergency care as uneven at best. Since then, telehealth has emerged as one of the great equalizers in care of children, particularly for those in rural and underresourced communities. Clinicians in these settings may lack pediatric‐specific specialization or experience in caring for critically ill or injured children. Telehealth consultation can provide timely and safe management for many medical problems in children and can prevent many unnecessary and often long transport to a pediatric center while avoiding delays in care, especially for time‐sensitive and acute interventions. Telehealth is an important component of pediatric readiness of hospitals and is a valuable tool in facilitating health care access in low resourced and critical access areas. This paper provides an overview of meaningful applications of telehealth programs in pediatric emergency medicine, discusses the impact of the COVID‐19 pandemic on these services, and highlights challenges in setting up, adopting, and maintaining telehealth services.

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Section: Additional Applications Of Telehealth In Pediatric Emergency...mentioning

confidence: 99%

The role of telehealth in pediatric emergency care

et al. 2023

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“…Only with assurance of portal account accuracy and confidentiality can the benefits of adolescent portal access be realized while mitigating risks. [6][7][8][9] Page 3 of 12…”

Section: Introductionmentioning

confidence: 99%

“…Only with assurance of portal account accuracy and confidentiality can the benefits of adolescent portal access be realized while mitigating risks. [6][7][8][9] Unfortunately, adolescent accounts have a high rate of potential access by individuals other than the patient which may lead to unintended disclosure of confidential information. 10 To address our institution's erroneously activated accounts, our Information Systems patient portal team developed a three-step approach to the problem: (1) clean-up existing, incorrectly activated accounts, (2) minimize opportunities to activate incorrect accounts (i.e., develop a "guardrail" for account activation), and (3) develop an ongoing, monitoring system to assess accuracy of newly activated accounts.…”

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confidence: 99%

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

et al. 2023

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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.

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“…Despite these benefits, most scholarship regarding adolescent portals has focused on implications for privacy and confidentiality . Of the few studies that explored adolescent engagement with portals, results have been mixed.…”

Section: Introductionmentioning

confidence: 99%

Engaging Adolescents in Using Online Patient Portals

Sisk,

Antes,

Bereitschaft

et al. 2023

JAMA Netw Open

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ImportanceMany health care systems offer adolescents access to health information through online patient portals, but few studies have explored how to engage adolescents in using and benefiting from online portals.ObjectiveTo determine how US children’s hospitals have attempted to encourage adolescent portal use, barriers to engaging adolescents, and ideal future goals for engagement.Design, Setting, and ParticipantsThis qualitative study performed structured qualitative interviews with informatics administrators from children’s hospitals across the US between February and July 2022. Informatics administrators were employed by US health care systems that managed a children’s hospital with at least 50 dedicated pediatrics beds. Data analysis was performed from November 2022 to January 2023.Main Outcomes and MeasuresThis study used thematic analysis of (1) current steps that health care systems had taken to engage adolescents in using their online patient portals and (2) barriers to engaging adolescents and ideal future goals and outcomes of engagement.ResultsAmong 58 total interviews with 65 informatics administrators who represented 63 hospitals across 58 health care systems, 6 themes of approaches to engaging adolescents in portal use were identified: (1) promoting and educating adolescents about portal enrollment, (2) establishing workflows to support enrollment, (3) seeking and incorporating feedback, (4) creating a culture or environment supporting engagement, (5) increasing portal utility, and (6) limited efforts. Barriers to engaging adolescents in portal use related to either (1) stakeholder investment, interest, and capabilities or (2) intersecting technical, ethical, and legal factors. Participants identified 4 ideal future efforts to engage adolescents: (1) develop adaptable private means of communication with adolescents, (2) use adolescent-centric user design, (3) enhance promotion and education about portal use, and (4) simplify and adapt workflows to encourage enrollment. Participants described 3 ideal outcomes of this future engagement: (1) provide education about current health, (2) prepare for transition to adulthood, and (3) improve digital health education of adolescents.Conclusions and RelevanceIn this qualitative study of informatics administrators, children’s hospitals across the US were found to have varying degrees of efforts to engage adolescents in using their portals. Most of these efforts focused on supporting adolescent enrollment, but fewer efforts focused on making the portal useful and interesting to adolescents.

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Patient portals for the adolescent and young adult population: Benefits, risks and guidance for use

Cited by 16 publications

References 44 publications

The role of telehealth in pediatric emergency care

The role of telehealth in pediatric emergency care

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

Engaging Adolescents in Using Online Patient Portals

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