179 - Confidentiality and Caring for Adolescent Patients in the Age of the 21st Century Cures Act.

Poster Number: 179
Publication Number: 179.142

Amy R. Paul, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Erica A. Bostick, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States

Background: Adolescents’ confidence that their health information will be kept confidential is essential to a trusting patient-provider relationship. The 21st Century Cures Act, designed to improve patients' access to their electronic health records (EHR), puts adolescents’ legally protected confidentiality at risk because parents with proxy access to a child’s EHR can obtain confidential information. Adolescent medicine providers recognize these risks, but implementing EHR safeguards to help all providers protect adolescent confidentiality is challenging, despite legal guarantees in most states.

Objective: To promote needed system-level Electronic Health Record (EHR) changes, we aimed to explore feasible, generalizable EHR strategies to improve the protection of adolescent confidentiality.

Design/Methods: In this quality improvement (QI) project, our study population was adolescents presenting to our clinic for new patient visits from 7/2020 to 7/2021. We analyzed each note for documentation of the patient’s EHR note-sharing preferences and proxy status. In PDSA Cycle 1, we introduced a new smartphrase that was pulled into the EHR templates to remind us to discuss confidentiality and proxy access. In Cycle 2, we solicited feedback regarding the smartphrase from Adolescent Medicine providers and modified it based on this input. Cycle 3 offered each provider an individualized performance report on their use of the smartphrase and whether they checked proxy status. We interpreted these actions as markers that the provider had a conversation about confidentiality and proxy preferences with the patient.

Results: Before initiating this QI project, virtually no confidentiality conversations were documented. Our post-intervention goal was that 25% of new patient visits would include a confidentiality conversation. In fact, after three PDSA cycles, the frequency of documented confidentiality conversations increased to 51% in patients < 18 years old and 61% in patients >18 years old. Documentation of note sharing preference increased to 47% in all patients. Provider checks of proxy status went from < 1% to 32%.Conclusion(s): Our three QI intervention cycles greatly increased the frequency of confidentiality conversations between providers and adolescent patients. Provider feedback suggested that sustaining this level was feasible. Likely barriers to frequent confidentiality conversations were time constraints and physician concerns about parental objections to losing proxy access.
Amy Paul, DO CVAmy Paul CV 12:15:21.pdf
Conversation regarding confidentiality documented in EHRDocumented Discussion Points Regarding Adolescent Confidentiality for New Patient Visits in the Division of Adolescent Medicine