{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:02:17Z","timestamp":1771844537019,"version":"3.50.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T00:00:00Z","timestamp":1558051200000},"content-version":"vor","delay-in-days":365,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"funder":[{"DOI":"10.13039\/100000133","name":"AHRQ","doi-asserted-by":"publisher","award":["HS021531"],"award-info":[{"award-number":["HS021531"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"NSF","doi-asserted-by":"publisher","award":["1652302"],"award-info":[{"award-number":["1652302"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Medical privacy policies, which are clear-cut for adults and young children, become ambiguous during adolescence. Yet medical organizations must establish unambiguous rules about patient and parental access to electronic patient portals. We conducted a national interview study to characterize the diversity in adolescent portal policies across a range of institutions and determine the factors influencing decisions about these policies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Within a sampling framework that ensured diversity of geography and medical organization type, we used purposive and snowball sampling to identify key informants. Semi-structured interviews were conducted and analyzed with inductive thematic analysis, followed by a member check.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We interviewed informants from 25 medical organizations. Policies established different degrees of adolescent access (from none to partial to complete), access ages (from 10 to 18 years), degrees of parental access, and types of information considered sensitive. Federal and state law did not dominate policy decisions. Other factors in the decision process were: technology capabilities; differing patient population needs; resources; community expectations; balance between information access and privacy; balance between promoting autonomy and promoting family shared decision-making; and tension between teen privacy and parental preferences. Some informants believed that clearer standards would simplify policy-making; others worried that standards could restrict high-quality polices.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In the absence of universally accepted standards, medical organizations typically undergo an arduous decision-making process to develop teen portal policies, weighing legal, economic, social, clinical, and technological factors. As a result, portal access policies are highly inconsistent across the United States and within individual states.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocy042","type":"journal-article","created":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T07:05:03Z","timestamp":1523343903000},"page":"1008-1017","source":"Crossref","is-referenced-by-count":57,"title":["Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process"],"prefix":"10.1093","volume":"25","author":[{"given":"Marianne","family":"Sharko","sequence":"first","affiliation":[{"name":"Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Wilcox","sequence":"additional","affiliation":[{"name":"School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew K","family":"Hong","sequence":"additional","affiliation":[{"name":"School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica S","family":"Ancker","sequence":"additional","affiliation":[{"name":"Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,5,17]]},"reference":[{"issue":"3","key":"2020110620011805800_ocy042-B1","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jadohealth.2008.07.015","article-title":"Adolescent access to online health services: perils and promise","volume":"44","author":"Moreno","year":"2009","journal-title":"J Adolesc Health"},{"key":"2020110620011805800_ocy042-B2","first-page":"628","article-title":"Adolescent and caregiver use of a tethered personal health record system","volume":"2016","author":"Hong","year":"2016","journal-title":"AMIA Annu Symp Proc"},{"issue":"9568","key":"2020110620011805800_ocy042-B3","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1016\/S0140-6736(07)60367-5","article-title":"Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential","volume":"369","author":"Bearinger","year":"2007","journal-title":"Lancet"},{"issue":"6","key":"2020110620011805800_ocy042-B4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6506a1","article-title":"Youth risk behavior surveillance\u2014United States, 2015","volume":"65","author":"Kann","year":"2016","journal-title":"MMWR Surveill Summ"},{"key":"2020110620011805800_ocy042-B5","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/j.ijgo.2015.02.006","article-title":"Adolescent sexual and reproductive health: the global challenges","volume":"131","author":"Morris","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"2020110620011805800_ocy042-B6","author":"National Alliance on Mental Illness","year":"2017"},{"issue":"3","key":"2020110620011805800_ocy042-B7","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":"Lehrer","year":"2007","journal-title":"J Adolesc Health"},{"issue":"11","key":"2020110620011805800_ocy042-B8","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1001\/jama.1993.03500110072038","article-title":"Confidentiality in health care. 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