Purpose

Managing confidential adolescent health information in patient portals presents unique challenges. Adolescent patients and guardians electronically access medical records and communicate with providers via portals. In confidential matters like sexual health, ensuring confidentiality is crucial. A key aspect of confidential portals is ensuring that the account is registered to and utilized by the intended user. Inappropriately registered or guardian-accessed adolescent portal accounts may lead to confidentiality breaches.

Methods

We used a quality improvement framework to develop screening methodologies to flag guardian-accessible accounts. Accounts of patients aged 12–17 were flagged via manual review of account emails and natural language processing of portal messages. We implemented a reconciliation program to correct affected accounts’ registered email. Clinics were notified about sign-up errors and educated on sign-up workflow. An electronic alert was created to check the adolescent’s email prior to account activation.

Results

After initial screening, 2,307 of 3,701 (62%) adolescent accounts were flagged as registered with a guardian’s email. Those accounts were notified to resolve their logins. After five notifications over 8 weeks, 266 of 2,307 accounts (12%) were corrected; the remaining 2,041 (88%) were deactivated.

Conclusions

The finding that 62% of adolescent portal accounts were used/accessed by guardians has significant confidentiality implications. In the context of the Cures Act Final Rule and increased information sharing, our institution’s experience with ensuring appropriate access to adolescent portal accounts is necessary, timely, and relevant. This study highlights ways to improve patient portal confidentiality and prompts institutions caring for adolescents to review their systems and processes.

中文翻译：

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在治愈法案最终规则时代确保青少年患者门户网站的机密性

目的

在患者门户中管理机密的青少年健康信息提出了独特的挑战。青少年患者和监护人以电子方式访问医疗记录并通过门户与提供者进行交流。在性健康等机密事务中，确保机密性至关重要。机密门户的一个关键方面是确保该帐户已注册给目标用户并由其使用。不当注册或监护人访问的青少年门户帐户可能会导致隐私泄露。

方法

我们使用质量改进框架来开发筛选方法来标记监护人可访问的帐户。12-17 岁患者的账户通过人工审查账户电子邮件和门户消息的自然语言处理进行标记。我们实施了一项核对计划，以更正受影响帐户的注册电子邮件。诊所收到有关注册错误的通知，并接受了有关注册工作流程的教育。创建了一个电子警报，以在激活帐户之前检查青少年的电子邮件。

结果

经过初步筛选，3,701 个 (62%) 青少年帐户中有 2,307 个被标记为已通过监护人的电子邮件注册。这些帐户被通知解决他们的登录问题。在 8 周内收到 5 次通知后，2,307 个帐户中的 266 个 (12%) 得到了纠正；其余 2,041 个 (88%) 已停用。

结论

62% 的青少年门户账户被监护人使用/访问这一发现具有重大的保密意义。在治愈法案最终规则和增加信息共享的背景下，我们机构在确保适当访问青少年门户帐户方面的经验是必要的、及时的和相关的。这项研究强调了提高患者门户机密性的方法，并促使照顾青少年的机构审查其系统和流程。