EHR confidentiality tests teen trust

The American Academy of Pediatrics published a policy statement in the November issue of its journal, Pediatrics, calling for modifications to electronic health records that would improve the privacy of teenage patients. The AAP said the source of the problem is that federal laws on EHRs don’t account for differing rules at the state level.

The Health Information Technology for Economic and Clinical Health Act requires EHRs to comply with the Health Insurance Portability and Accountability Act in regard to patient privacy and data security. However, the AAP said that does not adequately address the privacy needs of adolescents, which are set by states. As a result, most EHRs are incapable of providing protections to these patients.

The policy statement noted that most systems are not designed to restrict certain portions of a patient’s record. Without that, adolescents do not have the option to hide records referring to care that, under certain state laws, physicians do not have to share with the patient’s parent or guardian, such as treatment of a sexually transmitted infection.

“If adolescents cannot trust that their health information will be both private and secure, they may not seek these services,” the AAP wrote in its November report (link).

Twenty-four percent of girls 14 to 19 years old had contracted at least one STD, according to a December 2009 Pediatrics study (link). Additionally, the Centers for Disease Control and Prevention reported that even though people 15 to 24 years old represent only 25% of the sexually experienced population, they acquire nearly half of all new STDs.

Arash Anoshiravani, MD, MPH, an adolescent medicine specialist at Lucile Packard Children’s Hospital in Palo Alto, Calif., co-wrote a study in the November issue of Pediatrics that found at-risk teens, who tend to engage in riskier behavior and have worse health than other teens, were interested in having online access to their records. The majority of surveyed teens, who were incarcerated in the juvenile justice system, also expressed interest in sharing their records with physicians, but only half said they wanted to share them with their parents (link).

Dr. Anoshiravani said the next test will be developing and testing online health records designed to protect the privacy of the adolescents. But he said the biggest challenge will be addressing how those systems will allow the sharing of those records.

“It’s very difficult right now to meet the spirit and letter of the law around confidential health information in the areas of reproductive and mental health for adolescent patients,” he said.

Dr. Anoshiravani was the lead author of a commentary published in the November Journal of Adolescent Health that looked at the features EHRs should have to address privacy issues, many of which were detailed in the AAP policy statement. He and his co-authors said addressing the special needs of adolescents should start before an EHR implementation, and that the areas practices and hospitals should examine include:

• The scheduling and registration of adolescent visits.
• Paper release of information to parents.
• Sensitive information on paper-based emergency department and hospital discharge summaries.
• Problem lists and medication reconciliation of sensitive medications.
• Patient billing, explanation of benefits and postvisit surveys.

All these areas have the potential to expose information that, by law, teens have the right to keep private, the authors said (link).

“These stakeholders need to understand local regulatory requirements relevant to adolescent confidentiality, as well as the information that is released (or inadvertently shared) currently in order to adequately address any concerning areas during the transition to an [EHR] system,” they wrote.