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Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight
Background The 21st Century Cures Act mandates sharing electronic health records (EHRs) with patients. Health care providers must ensure confidential sharing of medical information with adolescents while maintaining parental insight into adolescent health. Given variability in state laws, provider...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10371408/ https://www.ncbi.nlm.nih.gov/pubmed/37130566 http://dx.doi.org/10.1055/a-2084-4650 |
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author | Elias, Jonathan Gossey, J. Travis Xi, Wenna Sharko, Marianne Robbins, Laura Bostwick, Susan Chang, Jane Lorenzi, Virginia Giatzikis, Vasiliki Scofi, Jean Trepp, Richard Lewis, Rachel |
author_facet | Elias, Jonathan Gossey, J. Travis Xi, Wenna Sharko, Marianne Robbins, Laura Bostwick, Susan Chang, Jane Lorenzi, Virginia Giatzikis, Vasiliki Scofi, Jean Trepp, Richard Lewis, Rachel |
author_sort | Elias, Jonathan |
collection | PubMed |
description | Background The 21st Century Cures Act mandates sharing electronic health records (EHRs) with patients. Health care providers must ensure confidential sharing of medical information with adolescents while maintaining parental insight into adolescent health. Given variability in state laws, provider opinions, EHR systems, and technological limitations, consensus on best practices to achieve adolescent clinical note sharing at scale is needed. Objectives This study aimed to identify an effective intervention process to implement adolescent clinical note sharing, including ensuring adolescent portal account registration accuracy, across a large multihospital health care system comprising inpatient, emergency, and ambulatory settings. Methods A query was built to assess portal account registration accuracy. At a large multihospital health care system, 80.0% of 12- to 17-year-old patient portal accounts were classified as inaccurately registered (IR) under a parent 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 reregister 29,599 portal accounts; (3) restriction of access to remaining IR and RAU accounts. Proxy portal configurations were also optimized. Subsequently, adolescent clinical note sharing was implemented. Results Distribution of standardized training materials decreased IR and increased AR accounts ( p = 0.0492 and 0.0058, respectively). Our email campaign (response rate: 26.8%) was most effective in decreasing IR and RAU accounts and increasing AR accounts ( p < 0.002 for all categories). Remaining IR and RAU accounts, 54.6% of adolescent portal accounts, were subsequently restricted. Postrestriction, IR accounts continued declining significantly ( p = 0.0056). Proxy portal enhancements with interventions deployed increased proxy portal account adoption. Conclusion A multistep intervention process can be utilized to effectively implement adolescent clinical note sharing at a large scale across care settings. Improvements to EHR technology, portal enrollment training, adolescent/proxy portal settings, detection, and automation in reenrollment of inaccurate portal accounts are needed to maintain integrity of adolescent portal access. |
format | Online Article Text |
id | pubmed-10371408 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-103714082023-07-27 Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight Elias, Jonathan Gossey, J. Travis Xi, Wenna Sharko, Marianne Robbins, Laura Bostwick, Susan Chang, Jane Lorenzi, Virginia Giatzikis, Vasiliki Scofi, Jean Trepp, Richard Lewis, Rachel Appl Clin Inform Background The 21st Century Cures Act mandates sharing electronic health records (EHRs) with patients. Health care providers must ensure confidential sharing of medical information with adolescents while maintaining parental insight into adolescent health. Given variability in state laws, provider opinions, EHR systems, and technological limitations, consensus on best practices to achieve adolescent clinical note sharing at scale is needed. Objectives This study aimed to identify an effective intervention process to implement adolescent clinical note sharing, including ensuring adolescent portal account registration accuracy, across a large multihospital health care system comprising inpatient, emergency, and ambulatory settings. Methods A query was built to assess portal account registration accuracy. At a large multihospital health care system, 80.0% of 12- to 17-year-old patient portal accounts were classified as inaccurately registered (IR) under a parent 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 reregister 29,599 portal accounts; (3) restriction of access to remaining IR and RAU accounts. Proxy portal configurations were also optimized. Subsequently, adolescent clinical note sharing was implemented. Results Distribution of standardized training materials decreased IR and increased AR accounts ( p = 0.0492 and 0.0058, respectively). Our email campaign (response rate: 26.8%) was most effective in decreasing IR and RAU accounts and increasing AR accounts ( p < 0.002 for all categories). Remaining IR and RAU accounts, 54.6% of adolescent portal accounts, were subsequently restricted. Postrestriction, IR accounts continued declining significantly ( p = 0.0056). Proxy portal enhancements with interventions deployed increased proxy portal account adoption. Conclusion A multistep intervention process can be utilized to effectively implement adolescent clinical note sharing at a large scale across care settings. Improvements to EHR technology, portal enrollment training, adolescent/proxy portal settings, detection, and automation in reenrollment of inaccurate portal accounts are needed to maintain integrity of adolescent portal access. Georg Thieme Verlag KG 2023-07-26 /pmc/articles/PMC10371408/ /pubmed/37130566 http://dx.doi.org/10.1055/a-2084-4650 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Elias, Jonathan Gossey, J. Travis Xi, Wenna Sharko, Marianne Robbins, Laura Bostwick, Susan Chang, Jane Lorenzi, Virginia Giatzikis, Vasiliki Scofi, Jean Trepp, Richard Lewis, Rachel Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight |
title | Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight |
title_full | Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight |
title_fullStr | Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight |
title_full_unstemmed | Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight |
title_short | Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight |
title_sort | sharing clinical notes while protecting adolescent confidentiality and maintaining parental insight |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10371408/ https://www.ncbi.nlm.nih.gov/pubmed/37130566 http://dx.doi.org/10.1055/a-2084-4650 |
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