Although much attention has been given to the benefits of electronic health records, EHRs pose serious challenges regarding the privacy of sensitive health information for minor adolescents and parents.

That is the opinion of researchers at Columbia University’s Mailman School of Public Health, published in a Jan. 6 viewpoint article in JAMA, the journal of the American Medical Association.

In the piece, Ronald Bayer, Robert Klitzman, M.D., and John Santelli, M.D., discuss two threats to confidentiality created by EHRs—the possibility of disclosure to parents of health information that the adolescent may wish to keep private, and disclosure to the adolescent of information that parents may wish to keep private.

“A principled commitment to confidentiality is not to be taken as representing any antagonism to effective communication between parents and adolescents,” states the article. As the authors point out, medical societies that focus on adolescent health strongly support confidential care for minors and state laws permit minor adolescents to be treated without parental consent. But they warn that because the EHR aggregates information for all care provided within an integrated health system, parents potentially will have electronic access to information from their children’s confidential medical visits and conversations with providers.

“Given this ethical, legal, and policy context, it is not surprising that the advent of EHRs has triggered a set of concerns,” write the authors. “In this context, the Society for Adolescent Health and Medicine and the American College of Obstetricians and Gynecologists issued important statements in May 2014 to address the confidentiality needs of minor adolescents. Clinicians were asked to notify adolescent patients that their patients might have access to the records and make available the option for referral to a clinician able to provide confidential care.”

Because most teens are unable to pay out-of-pocket costs for medications and doctor visits, another potential threat to confidentiality concerns the sending of explanations of benefits related to health insurance coverage to parents when adolescents receive confidential care, according to the authors. However, at the same time, they make the case that the threat of EHRs to confidentiality is a two-way street, which can also result in disclosure to adolescents of information that parents might want to keep confidential. 

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