By Angela Hunsberger, Senior Healthcare Consultant Hayes Management Consulting
To meet Meaningful Use, you’ve either implemented a patient portal or plan to do so in the near future. Perhaps you’ve rolled out your portal with limited functionality but now plan to optimize the technology to increase both patient and staff engagement. Regardless of which stage of Meaningful Use you are in, you need to weigh the challenges of portal engagement and patient privacy.
Patient portals require an extra layer of privacy. The goal is to make the portal as user-friendly as possible so that patients will use it while maintaining the security and privacy of all of your patients. So how do you strike the right balance?
As you formulate your strategy for patient engagement, think about potential safeguards as they relate to patient privacy and proxy access for minors and adults. Remember to include thoughts regarding the static patient information available on the portal (chart summary) combined with other portal functionality (secure messaging). With these in mind, there are two types of proxy access to contemplate for your portal policy; portal access for minors and adult-to-adult management.
Access for Minors
Traditionally, it is standard practice to follow state and local legislation regarding portal proxy access for minors. Because legislation differs in each state, unfortunately there is no one “golden rule” to follow for such access. Additionally, the specifics regarding privacy of “children” versus “teens” add to the confusion when deciding if and how proxy access is given.
For example, in your state the emancipation age of a minor may be 18 years old. However, the patient is protected for privacy for birth control at the age of thirteen. If the birth control appears on the patient’s medication list on the portal to a parent who has been given proxy access, are you in violation of this patient’s rights? Think about which configurations your portal vendor can offer to accommodate this scenario. Most portal vendors have a feature to “auto-emancipate” based on a certain age. Unfortunately, most do not have the option at this point in time to set granular rules based on diagnosis, medications, or lab results. This lack of control leaves your practice vulnerable.
There are other considerations when deciding on proxy access for minors, such as parental custody. Many portals are designed to designate access to one guardian. In the case of custody issues, what plan do you have in place regarding the minor’s portal account and is that policy communicated in your terms and conditions for portal use? Is your staff prepared to deal with this situation today? Answering these questions in advance for your practice is vital to the successful implementation of your portal.
Access for Adult-to-Adult Management
Another area to examine is proxy access for adult-to-adult management. A knee-jerk reaction may be to make all portal accounts unique and not linked to each other. But, consider the possibilities for patient engagement for spouse-to-spouse account management, geriatric patients needing assistance, and power of attorney portal access. Your organization needs to decide if this type of proxy access is allowed and how it will be managed within your organization.
Formulate a Proxy Policy
You should only decide on if and how proxy access will be handled after careful review of your state and local laws and only after you have consulted with your legal counsel, privacy officer, and leadership.
There are a number of portal configurations to consider, including the following.
- Offer minor access with a proxy, but exclude an age range
- Example: Patients ages 13-17 may not have a portal account
- Decide to deny portal access for minors all together
- Example: Patients under the age of 17 may not be given portal access
- Each patient (over the age of 18) has own portal account and it is up to them if they want to share it
- Example: An elderly patient chooses to share portal log in and password with son so he can assist her in managing her health online
- If you allow proxy access, what kind of patient release will you offer?
- Include information regarding what kind of information can be accessed online
- How will the patient submit this release? In person only? What information will you need to for identity verification?
- Incorporate instructions for the patient to revoke the release
- Ensure your portal terms and conditions online and authorizations that patient’s sign clearly outline the details of your policy
- Educate your staff on these policies and workflows so that they are prepared to act appropriately when the situation arises
As a healthcare consumer, I find it convenient to manage my family’s healthcare in one place. It is frustrating when I can pay some bills and schedule family appointments online, but then I have to call in to make a payment on my husband’s account. As a healthcare professional, I understand and accept the safeguards of patient privacy, but as a patient I want more functionality and more reasons to engage online. Things will run smoother when portal technology completely catches up with the rest of the world, because patients will only engage when it is convenient and easy for them to do so.
This article was originally published on Hayes Management Consulting and is republished here with permission.