Adolescent Health Information Privacy

Adolescent privacy laws vary in significant ways from state to state and may conflict with federal laws.¹ In addition to minor consent laws, clinicians treating adolescent patients should be familiar with state and federal medical information privacy laws as they relate to adolescent healthcare and should develop clear policies and protocols for appropriately protecting this confidential information.

A full discussion of the interplay between federal and state privacy laws concerning the treatment of adolescents is beyond the scope of this article. Online information is available from various sources, for example:

• “Health Information Law in the Context of Minors” (Sara Rosenbaum, JD, et al. Pediatrics. 2009;123(s2): s116-s121)
• “HIPAA for Professionals: Personal Representatives” (U.S. Department of Health and Human Services)
• “Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process” (The Society for Adolescent Health and Medicine and the American Academy of Pediatrics. Journal of Adolescent Health. 2016;58:374-377)

Medical Liability Risk Management Recommendations — Patient and Parent Education

Every practice should have policies and procedures associated with adolescent privacy, and every person in the practice should understand them and apply them consistently. When a child reaches adolescence, or when the practice accepts a new adolescent patient, it is important to educate the parent and patient about the practice’s medical information privacy policies and procedures, including the limits to confidentiality; for example, that confidentiality may be intentionally breached if the adolescent poses a threat to themself or others, and that billing policies, medical records, and appointment notification can inadvertently compromise confidentiality.²

Sending patients and parents a letter describing the practice’s adolescent patient confidentiality policy can set expectations prior to the patient’s first appointment as an adolescent. This information may be included in one letter, or the practice may choose to send separate letters. The letters can also be posted on the practice website, provided to the parent/patient again following the appointment and provided as handouts in the waiting room. The letter should validate the parents' role in their adolescent’s healthcare decision-making, but also outline the clinician’s role in fostering increasing patient autonomy in healthcare decision-making in preparation for adulthood.² Consider including the following issues in a patient/parent informational letter and reiterating these points in personal discussions with the parent and patient:^2,3,4

• Describe the effect that consent and privacy laws will have on the treatment of adolescent patients in your practice and parent access to medical information.
• Outline limits on privacy protections, for example:
  • Parents will be contacted if patients pose a threat to themselves or others.
  • Physicians are required to report certain sexual diseases and suspicion of physical or sexual abuse.
  • Health insurance documents and office billing can inadvertently breach confidentiality.
• Explain your policies on privately interviewing and examining adolescent patients.
• Although having adolescent patients communicate with parents and involve them in important healthcare decisions is ideal, in some cases adolescent patients may opt for no treatment if their parents will find out about it.

When discussing confidentiality with adolescent patients, consider including the following points:^2,3,4

• Explain that their parents will probably see some information about confidential services on EOBs if they are using their parent’s health insurance.
  • Ask the patient’s parent’s health insurer about its notification procedures and pass this information on to the patient.
  • Encourage the patient to contact the insurance company to request that sensitive treatment information not be provided to the policyholder via EOBs.
• Discuss with the adolescent patient how they should be contacted for treatment of sensitive conditions.
  • Ensure that the adolescent’s email and mobile phone contact information is on file and there is a system in place to alert staff to use these methods of contact when appropriate.
• Although it may be unlikely that adolescent patients can afford to independently pay for treatment, give them the option when there is a risk of inadvertent disclosure by third parties.
  • If patients do pay for treatment, ensure that bills and other payment information are not sent to their parents.

References

1. Richard C. Boldt. “Adolescent Decision Making: Legal Issues with Respect to Treatment for Substance Misuse and Mental Illness.” Journal of Health Care Law and Policy, 2012 75-115. Citing 42 USC 290dd-2(b)(2) and 42 C.F.R. §§ 2.1-2.67.

2. Melissa Weddle, et. al. “Confidentiality and Consent in Adolescent Substance Abuse: An Update.” , 2005. 7(3).

3. Jean Someshwar. “Adolescent Confidentiality: Where Are the Boundaries?” Pediatrics Consultant Live, 2009.

4. The Society for Adolescent Health and Medicine and the American Academy of Pediatrics. “Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process.” Journal of Adolescent Health, 2016;58:374-377.