Category Archives: Health information technology

New study highlights privacy questions in teenagers’ electronic health records

About Karen Blum

Karen Blum is AHCJ’s core topic leader on health IT. An independent journalist in the Baltimore area, she has written health IT stories for publications such as Pharmacy Practice News, Clinical Oncology News, Gastroenterology & Endoscopy News, General Surgery News and Infectious Disease Special Edition.

Photo by Evolution Labs via Flickr.

Adolescent online patient portals can be set up confidentially so information about pregnancy testing, sexually transmitted diseases, mental health, and drug and alcohol use, etc., are kept private from parents and guardians. But a new study published in JAMA Network Open from three children’s hospitals revealed that more than half of adolescents’ accounts were inappropriately accessed by parents and guardians.

The study suggests there is more work to do both in designing these portals and in educating parents and their teens about them, the authors said.

Study methodology

Participating sites included Stanford Children’s Health in Palo Alto, Calif.; Rady Children’s Hospital in San Diego; and Nationwide Children’s Hospital in Columbus, Ohio — all of which allow adolescents to have patient portal accounts. Guardians can register for proxy accounts.

Investigators used a natural language processing algorithm to analyze all messages sent from patient portal accounts for 13- to 18-year-olds from June 2014 through the end of February 2020 to identify notes sent by parents/guardians. Some manual reviews at each institution were also performed. The study looked for either third-person references to the adolescent, phrases such as “my child,” or incidences where the signature matched the name of a guardian on file.

A closer look at the results

Researchers analyzed 25,642 messages sent from 3,429 adolescent accounts across the three institutions. After adjusting for sensitivity and specificity of the algorithm, they found that an estimated 64-76% of all accounts with outbound messages were accessed by parents and guardians. Parent access decreased as patients aged, from 59-64% in records for 13- to 14-year-olds to 40-50% in those for 17- to 18-year-olds.

Compliance with federal regulations and state confidentiality and consent laws for adolescents requires a reliable mechanism to share protected health information without guardian knowledge, the authors said. Thus, the study suggests that adolescent portal accounts as they exist today may be lacking.

“The 21st Century Cures Act has encouraged the sharing of health information with patients, which we totally endorse and really want to happen,” said senior study author Natalie Pageler, M.D., the chief medical information officer for Stanford Children’s Health, and a clinical professor of pediatrics and medicine at Stanford University, in a phone interview. “It’s the right thing to do for patients and families. But we think this issue [of parents accessing their teenagers’ accounts] is under-recognized…Many parents are getting access to information that they shouldn’t be, which creates a risk for teens.”

This includes the risk that if teens don’t trust that they have a confidential relationship with their provider, they won’t seek the care they need, Pageler said. Worse, for some teens there may be a risk of physical violence or retribution from parents.

According to Pageler, teenagers should have their confidential accounts, and parents can set up a proxy one granting them access to other health information that doesn’t fall under the above-mentioned categories. But it’s tricky, as state laws regarding consent can vary.

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Federal information blocking rule: What health care journalists need to know

About Cheryl Clark

Cheryl Clark (@CherClarHealth) is a MedPage Today contributor and inewsource.org investigative journalist. For most of 27 years, she covered medicine and science for the San Diego Union-Tribune. After taking a buyout in 2008, she became senior quality editor for HealthLeaders Media.

Photo by Juhan Sonin via Flickr.

With so much focus — and rightly so — on COVID-19, it’s understandable that even the best health care journalists have overlooked a critically important patient safety story, one that few I know had even heard about.

On April 5, 2021, the federal Information Blocking rule went into effect, allowing basically anyone who provides health care, “defined as “actors,” to release electronic health records in 16 categories such as summary visit notes, lab and pathology reports, and imaging studies to the patient’s health portal as soon as they are available electronically. According to the rule, that means even before the doctor has had a chance to review them, and before the provider has had a chance to explain or discuss what’s in those documents with the patient. Talk about a huge culture shift. Continue reading

Remote patient monitoring the next wave in telehealth

About Karen Blum

Karen Blum is AHCJ’s core topic leader on health IT. An independent journalist in the Baltimore area, she has written health IT stories for publications such as Pharmacy Practice News, Clinical Oncology News, Gastroenterology & Endoscopy News, General Surgery News and Infectious Disease Special Edition.

Photo via health.mil.Kathlyn Chassey uses a home healthcare kit as part of the COVID-19 Remote Monitoring Program, a joint effort of the Virtual Medical Center and Brooke Army Medical Center, in San Antonio, Dec. 18, 2020.

Telehealth wasn’t the only health care technology that took off during the COVID-19 pandemic. Remote patient monitoring — the use of mobile devices to monitor patient vital signs at home, plus in-home or virtual visits by health care providers — also has increased due to the public health emergency.

Before the pandemic, a big challenge for remote monitoring was helping large health care organizations, systems and plans to prioritize implementing virtual care technologies beyond just a pilot phase, Drew Schiller, co-founder and CEO of the technology firm Validic, said during a recent webinar hosted by the American Telemedicine Association.

“We were stuck in this endless cycle of trying things,” Schiller said. But once the pandemic hit, remote monitoring, telehealth and other technologies “immediately jumped to the forefront” and showed everyone how they could be used to scale remote care,” he said: “It was obviously a regrettable circumstance … but from a health care technology perspective, it has advanced the industry at least five years, if not a full decade, in a very short amount of time. Continue reading

Apps for substance use disorders, other conditions, may not be as private as we think

About Karen Blum

Karen Blum is AHCJ’s core topic leader on health IT. An independent journalist in the Baltimore area, she has written health IT stories for publications such as Pharmacy Practice News, Clinical Oncology News, Gastroenterology & Endoscopy News, General Surgery News and Infectious Disease Special Edition.

Sara Morrison

Sara Morrison

About one in five Americans report using mobile health applications (apps), according to survey data published by Gallup in 2019. But users may not necessarily be aware that the personal information they enter in those apps frequently is shared with third-party vendors that make some of those apps’ features.

In a recent article for Vox’s Recode, tech reporter Sara Morrison took a deep dive into data privacy — or a potential lack thereof — among mobile apps for substance use disorders, with implications for all health apps. She also covered the outdated laws that allow developers to share users’ information, often without full disclosure. Continue reading

Virtual assistants’ role in health care still being explored though questions persist

About Karen Blum

Karen Blum is AHCJ’s core topic leader on health IT. An independent journalist in the Baltimore area, she has written health IT stories for publications such as Pharmacy Practice News, Clinical Oncology News, Gastroenterology & Endoscopy News, General Surgery News and Infectious Disease Special Edition.

Photo by Jan Antonin Kolar via Unsplash

The use of virtual assistant devices like Amazon Echo in health care settings has been featured in a number of news stories in recent years. But a lawsuit brought against Amazon this summer by four health care workers — in which they alleged they didn’t realize the devices could record their conversations — indicates that while plenty of people use these devices to check weather, play music or games, or research information, not everyone understands exactly how they operate.

In a class-action suit filed in Washington state on June 30 (Scott et al. v. Amazon.com, Inc.; case #2:21-cv-00883), the health care workers, including a New Jersey substance use counselor and a Georgia-based health care company customer service representative, alleged that their Amazon smart speaker devices recorded their private conversations about patients without their knowledge or intent, according to a write-up on classaction.org. Continue reading