(17) Balancing Confidentiality and Access in Adolescent Gynecology Practices: Responding to the 21st Century Cures Act

Background: The 21st Century Cures Act is a federal mandate which requires sharing clinical notes with patients. To be in compliance, there must be balance between parent/guardian access and adolescent privacy. Healthcare providers must ensure confidential sharing of medical information with adolescents while maintaining parent/guardian access to some health information. This is particularly important in the provision of reproductive health care, where patient privacy is paramount.

Methods: We sought to identify an intervention to implement adolescent clinical note sharing, ensuring adolescent portal account registration accuracy and correct proxy access for parents/guardians in two adolescent gynecology practices within a multi-hospital healthcare system. A query was built assessing portal account registration accuracy. Within this system, 80.0% of 12- to 17-year-old patient portal accounts were classified as inaccurately registered (IR) or registration accuracy unknown (RAU). To increase accurately registered (AR) accounts the following interventions were pursued: 1) distribution of standardized portal enrollment training; 2) patient outreach email campaign to accurately re-register portal accounts; 3) restriction of access to accounts not accurately registered. Proxy portal configurations were also optimized. In one practice, there was additional staff training staff in correct portal registration.

Results: Interventions had the following effect: Distribution of standardized training materials decreased IR and increased AR accounts without significance. The email campaign (response rate: 26.8% system-wide) was most effective in decreasing IR and increasing AR accounts (p=0.009 and p=0.013). Remaining IR and RAU accounts, 54.6% of accounts system-wide, were subsequently restricted. Post restriction, IR accounts continued declining and AR accounts continued increasing, without significance. Proxy portal enhancements with interventions deployed increased proxy portal account adoption overall. Trends observed for adolescent gynecology patients were similar to system-wide trends. Our last intervention, targeted training of staff, is underway.

Conclusions: A stepwise intervention approach can be effectively utilized to implement adolescent clinical note sharing for adolescent gynecology practices in a manner that achieves compliance with federal mandates, increases access to health records for adolescents and their parents/guardians while importantly, protecting adolescent privacy.