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The Prevalence of Confidential Content in Adolescent Progress Notes Prior to the 21st Century Cures Act Information Blocking Mandate.
Bedgood, Michael; Rabbani, Naveed; Brown, Conner; Goldstein, Rachel; Carlson, Jennifer L; Steinberg, Ethan; Powell, Austin; Pageler, Natalie M; Morse, Keith.
Affiliation
  • Bedgood M; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States.
  • Rabbani N; Information Services, Stanford Children's Health, Palo Alto, California, United States.
  • Brown C; California Department of Public Health, Coronavirus Science Branch, Richmond, California, United States.
  • Goldstein R; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States.
  • Carlson JL; Information Services, Stanford Children's Health, Palo Alto, California, United States.
  • Steinberg E; Information Services, Stanford Children's Health, Palo Alto, California, United States.
  • Powell A; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States.
  • Pageler NM; Information Services, Stanford Children's Health, Palo Alto, California, United States.
  • Morse K; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States.
Appl Clin Inform ; 14(2): 337-344, 2023 03.
Article in En | MEDLINE | ID: mdl-37137339
BACKGROUND: The 21st Century Cures Act information blocking final rule mandated the immediate and electronic release of health care data in 2020. There is anecdotal concern that a significant amount of information is documented in notes that would breach adolescent confidentiality if released electronically to a guardian. OBJECTIVES: The purpose of this study was to quantify the prevalence of confidential information, based on California laws, within progress notes for adolescent patients that would be released electronically and assess differences in prevalence across patient demographics. METHODS: This is a single-center retrospective chart review of outpatient progress notes written between January 1, 2016, and December 31, 2019, at a large suburban academic pediatric network. Notes were labeled into one of three confidential domains by five expert reviewers trained on a rubric defining confidential information for adolescents derived from California state law. Participants included a random sampling of eligible patients aged 12 to 17 years old at the time of note creation. Secondary analysis included prevalence of confidentiality across age, gender, language spoken, and patient race. RESULTS: Of 1,200 manually reviewed notes, 255 notes (21.3%) (95% confidence interval: 19-24%) contained confidential information. There was a similar distribution among gender and age and a majority of English speaking (83.9%) and white or Caucasian patients (41.2%) in the cohort. Confidential information was more likely to be found in notes for females (p < 0.05) as well as for English-speaking patients (p < 0.05). Older patients had a higher probability of notes containing confidential information (p < 0.05). CONCLUSION: This study demonstrates that there is a significant risk to breach adolescent confidentiality if historical progress notes are released electronically to proxies without further review or redaction. With increased sharing of health care data, there is a need to protect the privacy of the adolescents and prevent potential breaches of confidentiality.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Confidentiality / Privacy Type of study: Observational_studies / Prevalence_studies / Risk_factors_studies Limits: Adolescent / Child / Female / Humans Language: En Journal: Appl Clin Inform Year: 2023 Document type: Article Affiliation country: United States Country of publication: Germany

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Confidentiality / Privacy Type of study: Observational_studies / Prevalence_studies / Risk_factors_studies Limits: Adolescent / Child / Female / Humans Language: En Journal: Appl Clin Inform Year: 2023 Document type: Article Affiliation country: United States Country of publication: Germany