{'fraction_non_alphanumeric': 0.020676691729323307, 'fraction_numerical': 0.0018796992481203006, 'mean_word_length': 5.538083538083538, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Electronic health records and adolescent privacy.

Electronic Health Records and Adolescent Privacy To the Editor In their Viewpoint on the confidentiality of electronic health records (EHRs), Dr Bayer and colleagues1 made a compelling case that the benefits of EHRs must be weighed against the challenges they pose to adolescent and parental privacy. The authors correctly noted that unless clear confidentiality standards inform the design of EHRs, the greater access afforded by new technologies risks compromising patient privacy vis-à-vis minor adolescents and their parents. However, in the context of adolescent privacy, the authors made an assumption that undermines their argument: namely, that minor consent laws automatically assure confidentiality to adolescents empowered to provide their own informed consent to treatment. Unfortunately, this is not always the case. For example, Nevada law expressly authorizes the treatment of minors for abuse of a controlled substance without parental consent, while simultaneously directing physicians who do so to “make every reasonable effort” to inform the patient’s parents “within a reasonable time after treatment.”2 (In the special case of government-funded drug and alcohol abuse treatment programs, state laws such as Nevada’s are preempted by strict federal confidentiality regulations.3) The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule defers to state laws that directly address the role of parents in obtaining their children’s health information. Thus, to the extent that state law authorizes or requires the disclosure of minors’ health information to their parents or guardians, HIPAA does not afford additional protections to such records. Where state law is silent on the matter, HIPAA grants discretion to physicians’ “professional judgment.”4 As the authors pointed out, there is widespread consensus among experts in adolescent health that confidentiality is a key component to overcoming adolescents’ reluctance to seek care for sensitive conditions. Nevertheless, consent and privacy remain distinct legal concepts, such that the ability of minors to independently authorize treatment is “not automatically dispositive” of the right to shield related health information from their parents.5 This is true irrespective of whether the record is stored electronically or in hard copy. The challenge to adolescent confidentiality in EHRs is one not just of technical design but also of law. While the ethics of confidential care may be more or less a settled question within the medical community, the terrain of state laws on this issue remains highly variable.