Adolescents gain more ownership over their own health: We encourage adolescents to be active participants in their health care as a step toward becoming adults and to take on more responsibility. Potential for disclosure of laboratory results, prescriptions, and diagnoses may occur with itemized explanation of benefits statements. Parent or guardian access to the patient’s visit notes through the electronic patient portal poses the potential that confidential and sensitive information may be accessed, resulting in a breach of confidentiality and potentially adverse outcomes for the adolescent patient. I don’t do it right at the beginning of the visit. Elk Grove Village (IL): American Academy of Pediatrics; 2017. OpenNotes. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. One important consideration in consenting teenagers for confidential telehealth care is that billing procedures may pose a risk of breach in confidentiality, especially if Obstet Gynecol 2014;123:389–93. Leawood, KS: AAFP; 2018. INTRODUCTION. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement It builds trust: Experimenting with a range of behavior is common among adolescents and young adults. Available at: Promoting healthy relationships in adolescents. Additionally, they should be informed of any restrictions to the confidential nature of the relationship. patient’s developing capacity for decision making with the ongoing need for support and guidance from caring adults. Ohio physicians working in federally funded programs may provide birth control to teenagers without parental consent. Adolescents should be aware that certain insurance carriers itemize explanation of benefits statements 7. Special requirements for electronic medical records in adolescent medicine. If the doctor doesn’t ask you to leave the room, offer to do so — and make it clear that you don’t need to know what they talk about. No content on this site, regardless of date, ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Confidentiality refers to protection of privileged and private information shared during a health care encounter and in medical records that document the encounter 1. Practice Gap. Available at: https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law. If you tell me anything I think your parents should know, we will talk about how to tell them. With appropriate safeguards, EHRs may offer more security than traditional paper-record systems. The American College of Obstetricians and Gynecologists has neither solicited nor accepted any commercial involvement in the development of the content of this published product. Measures to ensure protection will vary based on the EHR system capabilities and institution-specific policies. Physicians also have a responsibility to protect the confidentiality of minor patients, within certain limits. For additional quantities, please contact sales@acog.org Committee on Adolescence, Council on Clinical and Information Technology. A teen’s health information cannot be shared with anyone—including parents or guardians—without the teen’s written permission, unless required by law or if the health care provider is concerned the teen might harm him or herself or … Confidentiality in pediatric and adolescent gynecology: when we can, when we can't, and when we're challenged. Sickle cell disease in newborns and children: What families should know and do, COVID-19 vaccines for children and teens: What we do — and don’t — know, Sleep well — and reduce your risk of dementia and death. In general, adolescents have the right to confidentiality concerning reproductive health services. According to Florida law, if you are under the age of 18, you do not need your parents’ permission to receive reproductive health care. Sometimes there are physical concerns that a teen doesn’t want to talk about in front of a parent — because they think it is silly, or because they are embarrassed, or because they don’t want to worry their parents. should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. The right of a mature minor to consent to medical care without previous parental or guardian consent has been recognized in many states.*. They found. All states and the District of Columbia allow minors to consent to sexually transmitted infection (STI) testing and treatment without parental permission 14. Once confidentiality is breeched, it is difficult to regain trust; so, obstetrician–gynecologists should make efforts to avoid the violation of the trust between the health care provider and patient. Available at: Esch T, Mejilla R, Anselmo M, Podtschaske B, Delbanco T, Walker J. Obstet Gynecol 2020;135:e43–50. 758. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. Sexual misconduct. 42 Respecting patient confidentiality is an essential part of good care; this applies when the patient is a child or young person as well as when the patient is an adult. Any concerns the patient has regarding the presence of a chaperone should be elicited and addressed if feasible. Similar recommendations are supported by the American Academy of Pediatrics and the Society for Adolescent Health and Medicine 18. Confidential health care means information from the teen’s clinic visit will be discussed only between the teen and the Teen and Young Adult Clinic team. This booklet seeks to clarify teenagers’ rights under New York State . Confidential care for adolescents is important because it encourages access to care and increases discussions about sensitive topics and behaviors that may substantially affect their health and well-being 4. ACOG Committee Opinion No. All rights reserved. Most EHRs have the capability for patients to view any combination of appointments, medication lists, allergies, most recent vital signs, laboratory values, health care provider notes, and communication between patient and health care provider. There are times when a parental or guardian proxy to the adolescent’s patient portal may be appropriate, such as when an adolescent lacks the capacity for decision making, including those adolescents with severe intellectual or development disabilities. The OpenNotes toolkit 22 offers resources for institutions that choose to provide patient access to health care providers’ notes. Obstetrician–gynecologists are encouraged to ensure conversation time alone with adolescents to clarify the adolescent’s privileges regarding the release of information and to obtain appropriate and preferred contact method. American College of Obstetricians and Gynecologists. Identify the patient’s preferred route of contact. youth may lie about their risk behaviors or not seek health care when concerned about confidentiality. (Health care providers should be cognizant of potential coercion by parent or guardian to maintain access.). The ACOG policies can be found on acog.org. Most EHRs were not designed to provide item-specific control over parental or guardian access and release of adolescent health care information. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. txhealthsteps.com *HEADDSSS: Stephens, M. B. Committee on Practice and Ambulatory Medicine. If the EHR system does not allow for procedures to maintain adolescent confidentiality, the obstetrician–gynecologist or staff should inform the patient that parents or guardians will have access to the records, and the patient should be given the option of referral to a health care provider who is required to provide confidential care. Nurses should provide confidential services as appropriate and promote policies in health care settings that protect these services. The staff is always available to discuss health problems or answer questions. First, we want to make sure that adolescent patients have access to health care to make sure that they are healthy and safe. Confidentiality is a core tenet of health care, particularly important in the area of adolescent reproductive health. I say that at their child’s age, I like to have some time alone with them. Implement systemwide changes: train front desk personnel and medical staff who work with EHRs and answer office phone calls to be aware of and advocate for the confidentiality of adolescent patients as they transition into the adult health care system Box 3. Read terms, Number 803 (Replaces Committee Opinion Number 599, May 2014). Additionally, it is costly for vendors to develop and maintain the levels of mandated confidentiality because the laws regarding confidentiality vary by state 4. Patient portals are mechanisms within the EHR system that provide patients with electronic access to their personal health record. Bell SK, Mejilla R, Anselmo M, Darer JD, Elmore JG, Leveille S, et al. 12 They also are embodied in numerous state and federal laws that have great significance for the application of the HIPAA privacy rule to adolescents' health information. law allows teenagers to obtain medical treatment – including “sensitive” health care, such as reproductive or mental health services – without their parents’ involvement or even knowledge. Even though you are under 18, your visit at Planned Parenthood and your test results are completely confidential and cannot be shared without your consent. Committee on Adolescence. After her mother leaves the room, she admits to being sexually active and tells you that she has had unprotected intercourse recently with her boyfriend and missed a period. Although laws vary by state, all minors have a right to some confidential health care. ACOG Committee Opinion No. Parent or guardian access to the patient’s visit notes through the electronic patient portal poses the potential that confidential and sensitive information may be accessed, resulting in a breach of confidentiality and potentially adverse outcomes for the adolescent patient. The ACOG policies can be found on acog.org. If, after counseling, the patient refuses the chaperone, this decision should be respected and documented in the medical record 11. Obstetrician–gynecologists who treat adolescent patients should provide resources for parents and caregivers and encourage continued parental involvement 10. Adolescents are beginning to take responsibility for their health care, and this should be encouraged and supported as they transition to adult patients. Useful sources of information on state laws include the Guttmacher Institute 14 and the Center for Adolescent Health & the Law 23. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 Protecting confidential health services for adolescents and young adults: strategies and considerations for health plans . American College of Obstetricians and Gynecologists 409 12th Street SW, Washington, DC 20024-2188. BMJ Qual Saf 2017;26:262–70. Retrieved November 15, 2019. New York, NY: Guttmacher Institute; 2019. That’s why my advice to parents is to not just let their teen have confidential time with their health care provider, but to encourage it. (Monday through Friday, 8:30 a.m. to 5 p.m. Over the past several decades, adolescents have gained many opportunities to receive confidential health care services, particularly for concerns It’s what my teen patients need me to do. Health Insurance Portability and Accountability Act (HIPAA) of 1996: When Congress passed HIPAA in 1996, the law was known primarily for its provisions that provide stronger health insurance protection for people leaving jobs and people with preexisting medical conditions. If the MD includes whatever was said in his/her chartnotes, then others can see it. However, there may be substantial cost to these safeguards, and constant reevaluation of protection is imperative. As a last resort, the health care provider should consider referral if confidential care cannot be provided. American Family Physician 74(7): 1151-1156. The concepts of informed consent and confidentiality are complex when the patient is an adolescent. J Adolesc Health 2012;51:409–14. In certain instances, specific billing modifiers used with preventative services provided under the Patient Protection and Affordable Care Act will generate nonitemized explanation of benefits statements. TIPS FOR EFFECTIVE COMMUNICATION WITH ADOLESCENT PATIENTS • Spend time talking with the young person and Add sensitive information into the prose of the visit note that is not included in billing or hospital searchable data. The position statement from the North American Society for Pediatric and Adolescent Gynecology (NASPAG) and the Society for Adolescent Health and Medicine (SAHM) offers recommendations to advocate for and protect adolescent confidentiality, and assist institutions and practices in meeting the information-sharing requirements. This document has been updated to include information on patient portals, guidance on the release of medical records, examples of ways to safeguard adolescent patients’ confidentiality, and talking points to use with parents and guardians. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.American College of Obstetricians and Gynecologists 409 12th Street SW, Washington, DC 20024-2188Confidentiality in adolescent health care. Many institutions struggle to meet the current standard for providing access to and maintaining the confidentiality of sensitive portions of the medical record as required by the Centers for Medicare and Medicaid Services 4. Obstetrician–gynecologists should not misinterpret consent required to provide health care services with consent required to provide education and counseling; that is, even when consent is required by a parent or guardian for provision of contraception, an obstetrician–gynecologist may still provide counseling about contraceptive options. Information will not be shared with parents, family members, friends or anyone else. Obstetrician–gynecologists and other health care providers who care for minors should be aware of federal and state laws that affect confidentiality. See Box 1 and ACOG Committee Opinion No. An overview of consent to reproductive health services by young people. Obstetrician–gynecologists should make clear to the patient what limitations, if any, exist in the EHR system. Confidential health care means information from the teen’s clinic visit will be discussed only between the teen and the Teen and Young Adult Clinic team. Ayoung person is more likely to disclose sensitive information if he or she is provided with confidential services and has time alone with the provider. Available at: National Institute for Health Care Management. American College of Obstetricians and Gynecologists Patient access varies widely across institutions and by the type of EHR used by the health care provider. an important part of the health care visit experience and allows for open communication about sensitive topics. At the initial visit, the obstetrician–gynecologist should discuss the following issues with the parent or guardian and the patient: 1) the meaning and importance of confidentiality; 2) the scope of confidentiality protection; and 3) the limitations of confidentiality 1. Obstetrician–gynecologists are encouraged to know their individual systems and institutional policies regarding confidentiality, EHRs, patient portals, and the open access for visit notes. It might include mental health concerns such as depression or anxiety, meaning a teen could miss the opportunity to get the mental health help they need. Once children have reached the teen years, they are old enough to be afforded a degree of doctor-patient confidentiality. We may have to disclose private information to protect a patient’s safety. Ohio physicians working in federally funded programs may provide birth control to … This document has been updated to include information on patient portals, guidance on the release of medical records, examples of ways to safeguard adolescent patients' confidentiality, and talking points to use with parents and guardians. By reading this page you agree to ACOG's Terms and Conditions. J Pediatr Adolesc Gynecol 2017;30:176–83. OpenNotes. I meet with them both first, to see what the parents are worried about (teens don’t always tell me), and to get updated on what is going on with the family (teens don’t always know). Concerns about confidentiality, management of high-risk behavior, parent/adolescent conflict, and emerging independence are part of the adolescent experience. This includes sexually transmitted infections, pregnancy, oral contraceptives, and rape evaluation. One aspect of the Cures Act will enable patients to have increased access, use and exchange of the health information in their electronic health records (EHRs). Statutes on the rights of minors to consent to health care services vary by state, and obstetrician–gynecologists and other health care providers should be familiar with the regulations that apply to their practice. Pediatrics 2017;140:e20172858. 796. Do not include specific laboratory data or counseling in after-visit summaries. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. As your adolescent’s doctor and as the parent (or guardian), we have two roles here. https://www.health.harvard.edu/blog/teens-and-confidentiality-2019081617627 • Each teenage visit will begin with the parent and teenager in the room together. Consent and Confidentiality. In Harvard Health Letter, you’ll find easy remedies and solutions to these common challenges and more. If the EHR system does not allow for procedures to maintain adolescent confidentiality, the obstetrician–gynecologist or staff should inform the patient that parents or guardians will have access to the records, and the patient should be given the option of referral to a health care provider who is required to provide confidential care. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.All ACOG committee members and authors have submitted a conflict of interest disclosure statement related to this published product. Committee Opinion No. If a patient declines a chaperone, it should be explained that the chaperone is an integral part of the clinical team whose role includes assisting with the examination and protecting the patient and the physician. In general, adolescents have the right to confidentiality concerning reproductive health services. Statutes vary by state, but minors may become emancipated when they marry, serve in active duty in the U.S. military, or obtain a declaration from the court. Obstetrician–gynecologists who work with adolescent patients have a unique perspective and are encouraged to work with their institutions to protect patients’ confidentiality. 758, Promoting Healthy Relationships in Adolescents, for potential talking points when discussing confidentiality with parents, guardians, and patients 10. When my primary care patients reach high school age, or sometimes before, I kick their parents out of the exam room. Providers should be aware that parents or guardians may coerce their adolescent into sharing portal login information in order to obtain access to the adolescent’s medical record. Obstetrician–gynecologists are encouraged to know their individual systems and institutional policies regarding confidentiality, EHRs, patient portals, and the open access for visit notes. Use of chaperones during the physical examination of the pediatric patient. Beginning with this issue, and continuing every other month, the APA Monitor on Psychology will feature "Ethics Rounds," in which APA's Ethics Office will answer questions about the ethical issues psychologists most commonly face. (2006). Recommendations for electronic health record use for delivery of adolescent health care. (2006). Engaging patients through open notes: an evaluation using mixed methods. In these cases, obstetrician–gynecologists and other health care providers should be cognizant of alternative ways to share information with the adolescent if coercion to access the adolescent’s login information is suspected. This gives the A complicated web of federal and state laws, professional ethics, and statutory interpretations by various courts govern minors’ Ford C, English A, Sigman G. Confidential health care for adolescents: position paper for the Society for Adolescent Medicine. American College of Obstetricians and Gynecologists. However, someone must give consent, or permission, for the teenager to receive health care at the clinic. ET). The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on acog.org or by calling the ACOG Resource Center.While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. Nurses should provide confidential services as appropriate and promote policies in health care settings that protect these services. Chapel Hill (NC): Center for Adolescent Health and the Law; 2010. While gaining the adolescents’ trust, we still encourage them to discuss issues with their parents or guardians. In a study published this year in the Journal of Pediatrics, researchers asked youth ages 14 to 24 about their opinions and experiences with confidentiality in their health care. An example of how to address this request: the health care provider can review the record to ensure there is no violation of confidentiality (eg, information on sexual activity, STI screening, or gender identity) and then contact the patient directly to make sure that the patient approves of the information contained before its release. An AAP-endorsed position statement is highlighting the need for practices and institutions to safeguard adolescent confidentiality in the implementation of portions of the federal 21st Century Cures Act. If protection of adolescent confidentiality is not possible within their electronic system, the information technology support within individual institutions should be employed to restrict parental access per HIPAA compliance. American College of Obstetricians and Gynecologists. I won’t go behind your back.”. As adolescents navigate this important developmental period, obstetrician–gynecologists should engage with them and promote best practices that protect adolescents’ vulnerability and assist them in developing autonomy.
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