Pediatric Informatics: Computer Applications in Child Health (Health ...

22 Privacy Issues 305
22.3 Pediatric Privacy and Confidentiality Issues
22.3.1 Infants and Children
For infants and children younger than the age of majority (depending on the
jurisdiction), privacy of health information is managed through parents or guardians.
Problems with privacy and security of health information may occur with:
Assignment of authentication, authority (and for which functions), and availability
of a child’s health information:
� For multiple individuals (such as both parents or shared guardianship)
� When parental or guardianship roles exist but are not recognized by the law
� When families are undergoing separation, divorce or other legal processes
� When children have statutory right to consent for confidential treatment
� When children reach the age of majority
� For children in foster care or emergent guardianship
Breaches of confidentiality and integrity of health information in children:
� With specific diagnoses that may not be openly shared (such as HIV)
� With legal issues that are not known by family members (adoption, foster care)
� With families who have high-profile relatives (politicians, etc.) or members
who work in health care (“within the system”)
22.3.2 Adolescents
Confidentiality in adolescent care is covered in Chapter 5. In adolescent health,
confidentiality in communications is a sine qua non between provider and patient. 2
Teens are legally allowed to consent for certain confidential health care and have
the right of “privileged communication” by rules of professional privilege. This
mandate also applies to nonprofessionals working under or supporting the clinician,
including the IT staff, system, and the EMR. Information assurance processes for
this population must be comprehensive, as inappropriate notification of health
issues may be communicated to parents and guardians through unintentional
data releases and insurance notifications. This is often closely bound to practice
workflows and reimbursement.
22.4 Common Issues and Scenarios
22.4.1 Consenting to Treatment
Only a legal parent or guardian can consent to treatment of a minor (except in
documented emergencies and by specific statute):