Commentary
Special Requirements for Electronic Medical Records in Adolescent Medicine

https://doi.org/10.1016/j.jadohealth.2012.08.003Get rights and content

Abstract

Adolescents are a group likely to seek and, perhaps, most likely to benefit from electronic access to health information. Despite significant advances in technical capabilities over the past decade, to date neither electronic medical record vendors nor many health care systems have adequately addressed the functionality and process design considerations needed to protect the confidentiality of adolescent patients in an electronic world. We propose a shared responsibility for creating the necessary tools and processes to maintain the adolescent confidentiality required by most states: (1) system vendors must provide key functionality in their products (adolescent privacy default settings, customizable privacy controls, proxy access, and health information exchange compatibility), and (2) health care institutions must systematically address relevant adolescent confidentiality policies and process design issues. We highlight the unique technical and process considerations relevant to this patient population, as well as the collaborative multistakeholder work required for adolescent patients to experience the potential benefits of both electronic medical records and participatory health information technology.

Section snippets

Patient Experience

Even in the least complicated adolescent health visits, privacy and confidentiality concerns related to EMRs can be significant and difficult to anticipate. In fact, a typical adolescent patient engaging the health care system can experience confidentiality issues at virtually every step of the process.

In the ambulatory setting, even the most straightforward situations present risks of inadvertent exposure of an adolescent patient's confidential information, including (1) calling a clinic to

Key EMR Functionality

Although commercial EMR vendors have improved functionality dramatically throughout the past decade, critical capabilities related to privacy and confidentiality in the care of adolescent patients are still either missing or haphazardly implemented. Protecting adolescents' privacy in the health care setting is supported by evidence of best practice, as well as required by law in most U.S. states [5], [16], [17]. Vendors must partner with clinicians and health care systems to identify and

Practical Tips for Health Care Providers Implementing and Optimizing an EMR

Concerns about EMRs in adolescent health care are not exclusively technical, and the entire burden of shaping EMRs to best address the health needs of adolescents cannot rest solely on EMR vendors. The process of implementing an EMR into a health care setting is a sociotechnical process, requiring not only a functional technology but also a deep consideration of the health care system's existing organization, processes, and culture. With well-defined policies and procedures related to

Conclusion

Privacy concerns are pervasive in adolescent health care, even in the most seemingly innocuous patient encounters. To date, neither EMR vendors nor many health care systems have adequately addressed the functionality and process design considerations needed to protect the confidentiality of adolescent patients. We propose that both EMR vendors and health care systems assume shared responsibility for creating the needed tools and processes. System vendors must provide key functionality in their

References (23)

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