Drs. Pasternak, Hawkins, and Schuman’s article in the April 2019 issue of Contemporary Pediatrics entitled, Adolescent privacy and the EHR, discusses the dilemmas and barriers that providers encounter daily in clinical practice in attempting to maintain confidentiality for their adolescent patient while simultaneously protecting the adolescent from potential harm. The challenge is daunting for providers as there are no nationally recognized, evidence-based standards addressing adolescent confidentiality and privacy issues in the delivery of quality healthcare to adolescents.
6 confidentiality barriers
In their article, Drs. Pasternak, Hawkins, and Schuman identify 6 key barriers that providers confront in the adolescent privacy realm:
1.) Maintaining confidentiality within the electronic health record (EHR) and during the transmission of confidential information among providers;
2). Lack of knowledge among healthcare providers about consent laws related to minors;
3). Lack of knowledge among providers about state and federal laws concerning consent of minors;
4). The potential for staff to inadvertently breach confidentiality while speaking with the adolescents and their parents or guardian;
5). Lack of a standardized EHR template to maintain adolescent confidentiality; and
6). Current standards for billing and coding for adolescents’ healthcare services that are sent directly by insurance companies to the parents who, by law, may keep their child on their private insurance until the child is aged 26 years.
The authors provide suggestions for creating practice policies addressing each of these confidentiality needs for their adolescent patients.
Trust, opportunities, and boundaries
Pediatric Nurse Practitioners (PNPs) confront similar confidentiality issues on a daily basis as they provide primary and episodic care to adolescents in a variety of practice settings including school-based health centers (SBHCs). Pediatric nurse practitioners often spend more time with adolescents in SBHCs because teenagers often develop a trusting relationship in these settings; are comfortable receiving healthcare with the PNPs; and often drop in for an “unscheduled visit - just to chat.” These encounters offer unique opportunities for PNPs to engage adolescents in discussions that extend beyond the usual boundaries of healthcare visits.
Pediatric nurse practitioners have opportunities to listen to adolescent concerns while they are growing in this “new world” that engages digital natives to react locally one minute and globally the next. Are their decisions safe? Decisions are often influenced by social media. Talking with teenagers about their decisions is an important part of each healthcare encounter. The question is: What can and cannot be included in the EHR to assure privacy and confidentiality for adolescents?
Advocate for change
Pediatric nurse practitioners must be advocates for change! It is time to inform state and federal legislatures of the potential for harm to adolescents who are not assured of a state and/or nationally recognized standard of confidentiality during healthcare encounters. We can advocate for educational instruction in high school health classes that enables adolescents to learn about informed decision-making to better understand healthcare issues they may encounter, as well as the meaning of informed consent.
Additionally, all NP members of the National Association of Pediatric Nurse Practitioners can present a strong, unified voice and collaborate with pediatric colleagues to assure confidentiality for adolescents in our care. The National Association of Pediatric Nurse Practitioners and the American College of Nurse Midwives can add their voices by joining colleagues at the American Academy of Pediatrics, the Society of Adolescent Health and Medicine, and the American College of Obstetricians and Gynecologists, to support changes by medical insurance companies to assure that policies concerning billing and coding for adolescents maintain the privacy protection afforded to adults. Positive change takes time and concerted effort. This struggle is worth the effort.