There is notable state law variability surrounding an adolescent's confidentiality related to consent for reproductive, sexual, and mental health care.
Notes at your fingertips: Open note considerations regarding pediatric and adolescent care
Section snippets
Background
The clinician's note is continually expanding its purpose and audience.1,2 What was originally developed to serve as a reminder of a patient's unique medical history and features, differential diagnosis reflections, and disease management approaches for the care team3 has expanded to serve the nonclinical needs of payers, quality monitors, and administrators.4 The recent OpenNotes5 movement and subsequent access expansion via the 21st Century Cures Act Information Blocking Rule (21CCA) is
Benefits and drawbacks
Even though the Health Insurance Portability and Accountability Act enables patients to legally access their medical records, the process was often cumbersome and costly.17 The OpenNotes initiative, launched in 2010, demonstrated that providing unprecedented and timely access to notes has many benefits.1,7,12 Documented benefits include improved medication adherence, patients’ increased sense of control and trust, and enhanced patient engagement.12,18, 19, 20, 21 The latter may be the most
Privacy and confidentiality
Technical limitations of personal health records (PHRs) and electronic health records (EHRs)
Prior to open notes, increased access to personal health records (PHRs) accelerated the discussion surrounding adolescent and pediatric privacy and confidentiality.15 Considerations for what should be made available to the patient and/or parent/guardian have been predetermined to some extent based on an adolescent's legal right to consent to their own healthcare regarding sexual and reproductive health in addition to substance abuse and mental health.14
However, technical limitations exist
Care settings
To date, the concept of open notes has largely been studied in the ambulatory setting with few institutions closing the gap to cover hospital-based care.
Training institutions
Academic medical centers provide yet another complexity to open notes.
Discussion
The historical patient-clinician walls are being broken down as this important relationship continues to transition from paternalistic to active collaboration and shared decision-making.1,7 Open notes are a reflection of this movement in addition to patient portals and legislation mandating easy access and ownership of one's own healthcare data. Many have struggled with the conceptual ‘one-size-fits-all’ note catering to diverse audiences.1 The recent mandate to enable open notes nationwide
Declaration of Competing Interest
No conflict of interest to report
Funding Source
None
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