The proliferation of patient portals may have stemmed from the Centers for Medicare and Medicaid Services’ Meaningful Use requirements, but their multitude of benefits, from increased patient engagement to optimized office workflows, is the real driving force behind this now-ubiquitous healthcare technology tool. When addressing the barriers to adoption, many focus on older patients or rural populations who may lack access to devices or the bandwidth needed to meaningfully use the portals. But there’s another patient population that represents just as many challenges when it comes to portal adoption and use—those under the age of 18 who almost always have a parent or legal guardian involved. How do you ensure privacy rules are followed? What should happen to parent or guardian access once the child reaches the age of medical consent?
Verifying the patient’s ‘personal representative’ and granting proxy access
The first major issue comes up during the patient portal recruitment process when establishing guardian authentication and proxy access.
“Adult portals are a bit easier on enrollment because the patient and guardian are the same,” David West, MD, medical director of Nemours Health Informatics, told Patient Engagement HIT. “In pediatrics, there is always more friction at the point of trying to make an account because you have to verify that the person you’re giving that account to is in fact a legal guardian.”
This responsibility falls on the provider, but it may not be as easy as it sounds. State laws can vary on guardianship (i.e. who is allowed to be named a minor’s personal representative). There also may be a custody decree that dictates which parent is or is not allowed to make healthcare decisions on behalf of the child.
Considering the age of medical consent
The age of medical consent varies widely from state to state. In Alabama, patients who are at least 14 years old may provide their own consent. In Colorado, it’s 18 unless the patient is emancipated and managing their own finances. In Tennessee, it happens at the age of 15. While some patient portals offer only one-size-fits-all access—meaning the patient and the guardian view the exact same information—providers of pediatric patients should look for portal technology that adjust access as the patient reaches the age of medical consent.
“Guardians may no longer see some or all secure messages between the patient and the provider, some appointments…and medication lists. In most cases, these protocols are geared toward protecting adolescent patient privacy with regard to reproductive health, although they may apply to other forms of healthcare, as well,” explains Patient Engagement HIT Editor Sara Heath in Balancing Patient Portal Privacy and Access for Pediatric Care.
Not only does the rebalancing of access ensure compliance with privacy rules, it also can go a long way toward encouraging adolescents to feel comfortable utilizing healthcare services and fostering open communication between patient and provider.
Evolving parent involvement
But the age of medical consent shouldn’t mark the end of parent involvement. While portal access may shift to the adolescent patient, providers should encourage patients to communicate openly with their parents, guardians or other trusted adults about their health. This position statement on confidentiality from the Society of Adolescent Medicine offers the following ideas:
• Discussing with adolescent patients the pros and cons of communication with parents; helping them see the potential advantages of increased communication with parents.
• Using parent questionnaires to remind parents to discuss a wide range of issues related to health with their adolescent children.