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

5 Special Health Information Needs of Adolescent Care 49
Obtaining a thorough health and behavioral history
Summarizing interview response data for clinician’s and educator’s use
Identifying and prioritizing problem areas and health needs
Providing appropriate health advice and local referrals
� Age-specific anticipatory guidance
� Pertinent, succinct health education videos
� Understandable take-home materials
5.4.3 Facilitating Communication with Adolescent Patients
Adolescents comfort with information and communication tools and devices and
their growing ubiquity may facilitate health care. Most messaging (cell phone, short
messaging services (SMS or texting) ) between clinic and adolescents is free of
office visit charges and confidential billing issues. Useful functions for adolescent
care include providing answers for confidential clinical matters and appointment
reminders. Use of electronic communication tools, such as cell phones, e-mail,
secure electronic messaging and text messaging is covered in Chapter 23.
5.4.4 Improving Access to Teen Health Information
When children reach the age to consent to certain confidential services (varies by
state), laws regarding proxy access to patient health information apply. At this point,
parents/guardians lose their right to access a child’s (adolescent) record (unless there
are issues of patient competency). The impact of this has many dimensions. In addition
to adolescent privacy issues, there may be health issues that the parent/guardian
has not disclosed to the child. Communication and information access plans should
notify caregivers and patients about local laws and practice policies regarding proxy
access to teen PHI, including the age at which a teen can legally consent to procedures/treatments
(which is also the age at which the teen alone is allowed direct
access to the medical record regarding those procedures/treatments).
Direct access by teens is impacted by the Children’s Online Privacy Protection
Act, which requires “verifiable parental consent” for online transactions (i.e., direct
access) for children under the age of 13. In addition, unanticipated disclosures may
result from business/insurance notifications of care (as in Case Study 1).
5.4.5 Educating Teens About Health
Appropriate anticipatory and routine health guidance may be provided by a variety
of information technology and media within the clinic setting (audio-visual materials,
computer-based interactive multimedia, and/or vetted Internet sites). 20,21