The Royal New Zealand College of General Practitioners has produced a guide for general practice on the often complex issue of access to young people’s health information via patient portals.
Child and Adolescent Health: Patient Portals, Health Information and Disclosure covers GPs’ ethical duties and legal requirements. It provides a suggested framework for considering requests for portal access to the health information of a young person and a flowchart of key decision points when determining portal access to the information.
Six case studies provide GPs with guidance for the most common scenarios that might arise, such as when a young person asks to limit parental access; and portal access when parents are divorcing.
College President, Dr Tim Malloy, says the College has developed the guide with others in the sector, including the Ministry of Health and the Office of the Privacy Commissioner, to help GPs understand what is expected of them.
“Patient portals have the potential to allow patients and general practice teams to interact in a more meaningful way and lead to better patient outcomes. However, providing a patient portal can also present issues that need to be worked through, particularly when adolescents are involved.”
Dr Malloy says providing access to electronic clinical records does not change a GP’s obligations around patient confidentiality and privacy of health information.
Legal considerations include the Health Information Privacy Code, informed consent and competency, and informed consent and disclosure of health information.
He says when responding to a parent’s request to access their young person’s health information, GPs are faced with the competing interests of their ethical duty of confidentiality to their patient and a parent who wants or needs to know about their young person’s clinical situation.
“Trust, confidentiality and privacy need to be taken into account when deciding whether or not to disclose information.
“For example, you might have set up a patient portal for a 10-year-old that gives her parents the ability to access her health information on her behalf, but that arrangement is unlikely to be appropriate when she grows into a 15-year-old who comes to you to discuss her alcohol consumption.”
He says understanding cultural needs is also important. “In many cultures, decision making about young people involves their whānau and extended family networks, as well as the young person and their parents. GPs need to be aware of cultural needs, discuss them with the young person and consider seeking guidance on cross-cultural communication from an expert experienced in youth development.”
Dr Malloy says decisions about access to records usually don’t need to be made quickly.
“GPs shouldn’t be rushed into an answer, particularly when they are required to consider the competence of a patient.”
Members of the RNZCGP can log in and download the guide from The Royal New Zealand College of General Practitioners' website.
GPs endorse use of patient portals
The Technology Workforce Survey, newly released by the College, found that among respondents working in practices that provided at least some patients with access to a patient portal, 86 percent considered that this had resulted in an improvement in the ability of the practice to provide services to patients.
This was even more marked among respondents from practices where the portal was available to all patients, with 91 percent considering there had been an improvement. These respondents also scored the degree of improvement more highly than respondents from practices with only partial availability.