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- Title
Assessment of Prevalence of Adolescent Patient Portal Account Access by Guardians.
- Authors
Ip, Wui; Yang, Samuel; Parker, Jacob; Powell, Austin; Xie, James; Morse, Keith; Aikens, Rachael C.; Lee, Jennifer; Gill, Manjot; Vundavalli, Shravani; Huang, Yungui; Huang, Jeannie; Chen, Jonathan H.; Hoffman, Jeffrey; Kuelbs, Cynthia; Pageler, Natalie
- Abstract
Key Points: Question: How frequently are adolescent patient portal accounts accessed by guardians? Findings: In this cross-sectional study including 3429 adolescent accounts across 3 academic institutions, analysis of portal messages found that more than half of adolescent patient portal accounts with outbound messages were accessed by guardians. The percentage of accessed accounts was greater in children aged 13 to 14 years vs those aged 17 to 18 years. Meaning: These findings may be useful in guiding health system approaches to protecting adolescent confidentiality when sharing health data via patient portals. Importance: Patient portals can be configured to allow confidential communication for adolescents' sensitive health care information. Guardian access of adolescent patient portal accounts could compromise adolescents' confidentiality. Objective: To estimate the prevalence of guardian access to adolescent patient portals at 3 academic children's hospitals. Design, Setting, and Participants: A cross-sectional study to estimate the prevalence of guardian access to adolescent patient portal accounts was conducted at 3 academic children's hospitals. Adolescent patients (aged 13-18 years) with access to their patient portal account with at least 1 outbound message from their portal during the study period were included. A rule-based natural language processing algorithm was used to analyze all portal messages from June 1, 2014, to February 28, 2020, and identify any message sent by guardians. The sensitivity and specificity of the algorithm at each institution was estimated through manual review of a stratified subsample of patient accounts. The overall proportion of accounts with guardian access was estimated after correcting for the sensitivity and specificity of the natural language processing algorithm. Exposures: Use of patient portal. Main Outcome and Measures: Percentage of adolescent portal accounts indicating guardian access. Results: A total of 3429 eligible adolescent accounts containing 25 642 messages across 3 institutions were analyzed. A total of 1797 adolescents (52%) were female and mean (SD) age was 15.6 (1.6) years. The percentage of adolescent portal accounts with apparent guardian access ranged from 52% to 57% across the 3 institutions. After correcting for the sensitivity and specificity of the algorithm based on manual review of 200 accounts per institution, an estimated 64% (95% CI, 59%-69%) to 76% (95% CI, 73%-88%) of accounts with outbound messages were accessed by guardians across the 3 institutions. Conclusions and Relevance: In this study, more than half of adolescent accounts with outbound messages were estimated to have been accessed by guardians at least once. These findings have implications for health systems intending to rely on separate adolescent accounts to protect adolescent confidentiality. This cross-sectional study uses a natural language processing algorithm to estimate prevalence of access of adolescent patient portal accounts by guardians at 3 academic children's hospitals.
- Subjects
ACADEMIC medical centers; CONFIDENCE intervals; CHILDREN'S hospitals; CROSS-sectional method; NATURAL language processing; ACCESS to information; GUARDIAN &; ward; DESCRIPTIVE statistics; STATISTICAL sampling; ODDS ratio; ALGORITHMS
- Publication
JAMA Network Open, 2021, Vol 4, Issue 9, pe2124733
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.24733