Jan. 16 2015

Electronic health records are heralded as the greatest thing since the stethoscope. Moving away from paper, the argument goes, makes it easier for physicians to stay current on patients’ medical histories, and for patients to see their own information in order to take charge of their health.

But ease of access is a double-edged sword when it comes to privacy between teenagers and their parents, argue three professors at the Mailman School of Public Health at Columbia University in a Journal of the American Medical Association opinion piece.

John Santelli, one of the authors and chair of the Heilbrunn Department of Population and Family Health, explains that there are times when teenagers will want to keep their medical history from their parent. Reasons include getting a prescription for birth control, testing or treatment for a sexually transmitted infection, and a mental health issue.

“But when a teen realizes that it only takes a few keystrokes by a parent to access the entirely of their medical record, they may be less likely to seek care when they need it,” says Santelli, the former president of the Society for Adolescent Health and Medicine.

The argument isn’t against communication between parent and child. “Parents play a crucial role in promoting adolescent health and wellbeing,” Santelli explains. “On the other hand, we know that not all parents are supportive on every issue.”

Teens’ right to confidential care is broadly supported by the medical community and protected by laws in all states and the District of Columbia. So-called minor consent laws shield teens from their parents when it comes to certain kinds of care like sexual and mental health. In the days of paper records, information protected by minor consent laws was filed separately and far from the prying parental eyes.

The era of electronic health records has weakened these protections, argue Santelli and co-authors Ronald Bayer and Robert Klitzman. Using an Internet portal, parents have easy access to the totality of their teen’s health information until their 18th birthday. It doesn’t even take a nosy parent for a privacy breach to occur: health insurance companies commonly send benefits statements that detail information like lab tests and prescriptions.

Fixing the problem, the professors observe, is less an issue of ethics and the law, which are already settled, than an indication of a need for better enforcement of existing privacy protections as well as technical solutions to keep confidential records separate.

Parents Deserve Privacy Too

Of course, what goes around comes around. Less settled—and so far little discussed—is the question of parental privacy, the expectations of those who may not wish to share details of genetic testing and psychiatric treatment, for example, with their child.

“It’s important to strike a balance between a parent’s right to privacy and the child’s right to information that may have a critical impact on health,” says Bayer, a professor of Sociomedical Sciences and noted ethicist. “We need a clear standard of confidentiality in electronic medical records that protects both parents and adolescents.”