The Prevalence of Confidential Content in Adolescent Progress Notes Prior to the 21st Century Cures Act Information Blocking Mandate

Abstract Background  The 21st Century Cures Act information blocking final rule mandated the immediate and electronic release of health care data in 2020. There is anecdotal concern that a significant amount of information is documented in notes that would breach adolescent confidentiality if releas...

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Bibliographic Details
Published in:Applied clinical informatics 2023-03, Vol.14 (2), p.337-344
Main Authors: Bedgood, Michael, Rabbani, Naveed, Brown, Conner, Goldstein, Rachel, Carlson, Jennifer L., Steinberg, Ethan, Powell, Austin, Pageler, Natalie M., Morse, Keith
Format: Article
Language:English
Subjects:
Adolescent
Adolescent Privacy and the Electronic Health Record
Child
Confidentiality
Female
Health Facilities
Humans
Prevalence
Privacy
Retrospective Studies
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Summary:Abstract Background  The 21st Century Cures Act information blocking final rule mandated the immediate and electronic release of health care data in 2020. There is anecdotal concern that a significant amount of information is documented in notes that would breach adolescent confidentiality if released electronically to a guardian. Objectives  The purpose of this study was to quantify the prevalence of confidential information, based on California laws, within progress notes for adolescent patients that would be released electronically and assess differences in prevalence across patient demographics. Methods  This is a single-center retrospective chart review of outpatient progress notes written between January 1, 2016, and December 31, 2019, at a large suburban academic pediatric network. Notes were labeled into one of three confidential domains by five expert reviewers trained on a rubric defining confidential information for adolescents derived from California state law. Participants included a random sampling of eligible patients aged 12 to 17 years old at the time of note creation. Secondary analysis included prevalence of confidentiality across age, gender, language spoken, and patient race. Results  Of 1,200 manually reviewed notes, 255 notes (21.3%) (95% confidence interval: 19–24%) contained confidential information. There was a similar distribution among gender and age and a majority of English speaking (83.9%) and white or Caucasian patients (41.2%) in the cohort. Confidential information was more likely to be found in notes for females ( p  
ISSN:1869-0327
1869-0327
DOI:10.1055/s-0043-1767682