The Wall Street Journal on Wednesday examined how federal and state laws regarding access to adolescents' medical files are affecting the development of electronic health records. Federal and state laws allowing teenagers to seek without their parents' consent various medical services, such as mental health treatment or family planning services, also "make certain aspects of [their] health records off-limits to parents," the Journal reports. While parents can access their teenagers' nonconfidential paper records, EHR systems thus far do not have a way to prevent parents from accessing confidential material. As a result, many EHR providers are "revoking parental access to children's records as soon as they turn 13," according to the Journal. In addition, teenagers generally cannot access their own records because their status as a minor does not permit them to enter into the necessary security agreements for EHRs. Because of the current structure and rules, most teens are unable to benefit from the advances of EHRs and other health information technology initiatives, such as secure e-mail communications with their care providers, the Journal reports.

Changing the System
Several groups are working on allowing parents and teenagers access to EHRs without breaking confidentiality or access rules, according to the Journal. For example, the American Academy of Pediatrics is reviewing its policy on patients' rights and privacy protections for minors, and software developers also are working on more sophisticated records systems. Kaiser Permanente also is developing an agreement that allows adults to access medical records of adult family members for whom they are caregivers, such as a sick spouse, elderly parent and minor children. "Who should access teen information is a difficult issue; the laws are subtle and do not always provide clear direction," Tim McKay, senior practice leader at Kaiser Permanente's Internet Services Group, said. Andrew Spooner, director of general pediatrics at the University of Tennessee College of Medicine, said that EHR developers eventually could develop technology that could automatically determine parental access by using a patient's age and a state's laws (Landro, Wall Street Journal, 8/24).