{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:02:21Z","timestamp":1771844541052,"version":"3.50.1"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003The 21st Century Cures Act mandates sharing electronic health records (EHRs) with patients. Health care providers must ensure confidential sharing of medical information with adolescents while maintaining parental insight into adolescent health. Given variability in state laws, provider opinions, EHR systems, and technological limitations, consensus on best practices to achieve adolescent clinical note sharing at scale is needed.<\/jats:p><jats:p>\n          Objectives\u2003This study aimed to identify an effective intervention process to implement adolescent clinical note sharing, including ensuring adolescent portal account registration accuracy, across a large multihospital health care system comprising inpatient, emergency, and ambulatory settings.<\/jats:p><jats:p>\n          Methods\u2003A query was built to assess portal account registration accuracy. At a large multihospital health care system, 80.0% of 12- to 17-year-old patient portal accounts were classified as inaccurately registered (IR) under a parent or registration accuracy unknown (RAU). To increase accurately registered (AR) accounts, the following interventions were pursued: (1) distribution of standardized portal enrollment training; (2) patient outreach email campaign to reregister 29,599 portal accounts; (3) restriction of access to remaining IR and RAU accounts. Proxy portal configurations were also optimized. Subsequently, adolescent clinical note sharing was implemented.<\/jats:p><jats:p>\n          Results\u2003Distribution of standardized training materials decreased IR and increased AR accounts (p\u2009=\u20090.0492 and 0.0058, respectively). Our email campaign (response rate: 26.8%) was most effective in decreasing IR and RAU accounts and increasing AR accounts (p\u2009&lt;\u20090.002 for all categories). Remaining IR and RAU accounts, 54.6% of adolescent portal accounts, were subsequently restricted. Postrestriction, IR accounts continued declining significantly (p\u2009=\u20090.0056). Proxy portal enhancements with interventions deployed increased proxy portal account adoption.<\/jats:p><jats:p>\n          Conclusion\u2003A multistep intervention process can be utilized to effectively implement adolescent clinical note sharing at a large scale across care settings. Improvements to EHR technology, portal enrollment training, adolescent\/proxy portal settings, detection, and automation in reenrollment of inaccurate portal accounts are needed to maintain integrity of adolescent portal access.<\/jats:p>","DOI":"10.1055\/a-2084-4650","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T23:15:40Z","timestamp":1683069340000},"page":"555-565","source":"Crossref","is-referenced-by-count":8,"title":["Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight"],"prefix":"10.1055","volume":"14","author":[{"given":"Jonathan","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Primary Care, Weill Cornell Medicine, New York, New York, United States"},{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States"}]},{"given":"J. Travis","family":"Gossey","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States"},{"name":"Department of Medicine, Weill Cornell Medical Center, New York, New York, United States"}]},{"given":"Wenna","family":"Xi","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States"}]},{"given":"Marianne","family":"Sharko","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States"},{"name":"Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States"}]},{"given":"Laura","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Morgan Stanley Children's Hospital, New York, New York, United States"}]},{"given":"Susan","family":"Bostwick","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States"}]},{"given":"Jane","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States"}]},{"given":"Virginia","family":"Lorenzi","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian Hospital, New York, New York, United States"},{"name":"Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, United States"}]},{"given":"Vasiliki","family":"Giatzikis","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian Hospital, New York, New York, United States"}]},{"given":"Jean","family":"Scofi","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States"},{"name":"Department of Emergency Medicine, Weill Cornell Medical Center, New York, New York, United States"}]},{"given":"Richard","family":"Trepp","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, United States"}]},{"given":"Rachel","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ColumbiaDoctors, New York, New York, United States"}]}],"member":"194","published-online":{"date-parts":[[2023,7,26]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1001\/jama.1997.03550120089044","article-title":"Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial","volume":"278","author":"C A Ford","year":"1997","journal-title":"JAMA"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jadohealth.2006.09.015","article-title":"Forgone Health Care among U.S. Adolescents: Associations between Risk Characteristics and Confidentiality Concern","volume":"40","author":"J A Lehrer","year":"2007","journal-title":"J Adolesc Heal"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.jadohealth.2014.01.011","article-title":"Recommendations for electronic health record use for delivery of adolescent health care","volume":"54","author":"S H Gray","year":"2014","journal-title":"J Adolesc Health"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jadohealth.2020.10.020","article-title":"NASPAG\/SAHM statement: the 21st century cures act and adolescent confidentiality","volume":"68","author":"J Carlson","year":"2021","journal-title":"J Adolesc Health"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1097\/AOG.0000000000003770","article-title":"Confidentiality in adolescent health care: ACOG committee opinion, number 803","volume":"135","author":"Confidentiality in Adolescent Health Care","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1542\/peds.2012-2580","article-title":"Standards for health information technology to ensure adolescent privacy","volume":"130","author":"M J Blythe","year":"2012","journal-title":"Pediatrics"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jpeds.2019.06.052","article-title":"Adolescents' and young adults' satisfaction with and understanding of medical notes from a pediatric gastroenterology practice: a cross-sectional cohort study","volume":"215","author":"J S Huang","year":"2019","journal-title":"J Pediatr"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"e2021053458","DOI":"10.1542\/peds.2021-053458","article-title":"State-by-state variability in adolescent privacy laws","volume":"149","author":"M Sharko","year":"2022","journal-title":"Pediatrics"},{"issue":"04","key":"ref9","first-page":"667","article-title":"Minors' rights to consent to treatment: navigating the complexity of State laws","volume":"37","author":"D M Vukadinovich","year":"2004","journal-title":"J Health Law"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jadohealth.2021.09.006","article-title":"Twenty-first century cures act final rule and adolescent health care: leadership education in adolescent health (LEAH) program experiences","volume":"69","author":"C A Ford","year":"2021","journal-title":"J Adolesc 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Inform"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2084-4650.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T23:12:47Z","timestamp":1690413167000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2084-4650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":16,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2023,5,24]]},"published-print":{"date-parts":[[2023,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2084-4650","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5,2]]},"published":{"date-parts":[[2023,5]]}}}