mHealth and Adolescents: Deciding Privacy vs. Patient Needs

Technology serves as a way to instantly connect patient and physician in an emergency situation. But when it comes to treating adolescents, there’s sometimes a small window to debate preserving privacy versus addressing urgent patient needs.

Susan J. Kressly, MD, a Warrington, Pa.-based pediatrician, began her session at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference in Las Vegas with a warning to all in attendance.

"I'm going to be real here, so if you're easily offended, you may want to go get coffee now. Anyone who takes care of teenagers knows there's going to be sex, drugs, and behavioral health things involved," she said.

For her first example, Kressly recalled a time when a college student used FaceTime to contact her late at night. The student was concerned about her roommate who was drunk and breathing funny. Kressly explained that she had told the student to contact her whenever she needed, so the student felt comfortable taking her up on that offer.

Having cared for adolescents since 1990, Kressly knows kids in such a predicament do not have the patience to log onto a secure portal. "They are not going to do it. And I would argue that I have to make a quick decision whether to call 911 or tell the student to get an [resident assistant] to help. If I tell them to call 911, there's a chain of events that’s going to happen; someone could get kicked out of college," said Kressly.

To assist physicians with a situation like the one above, Kressly would like to see a solution that is patient-centered, able to assist them where they are, and is quick, easy, and free.

"To me, this is a problem that is waiting for an innovator to solve," said Kressly, urging any innovators in attendance to run with the idea. 

Kressly later described a call she received from a teenager in her closet, whispering in hopes not to get caught by her mom. She and her boyfriend had engaged in sexual intercourse and the condom had broken. Not knowing what to do, she turned to Kressly for help.

"[The teenager said] ‘I want to go on the pill. My mom doesn't know me and my boyfriend are having sex and I'm not ready to tell her. Can you help me?,’" recalled Kressly.

Because the adolescent was not considered an adult, Kressly was left in a precarious position.

"When a kid reaches out for help as a trusted healthcare provider, we need to figure out a way to be able to help them. My first thought is not privacy and security, it's taking care of the needs of the patients who are looking for me," said Kressly.

As soon as Kressly writes a prescription for an adolescent, the payer will submit the data to the parents as part of the explanation of benefits, undoing any privacy Kressly had with that patient.

To allow for more privacy between her and adolescent patients, Kressly suggesting the idea of creating standards for tagging privacy at the granular data element level. Some examples of these data elements included medications, lab orders and results, and counseling section of notes.

In addition, Kressly suggested the implementation of standards for staff "roles" on privacy settings. For example, some levels of privacy could include any staff member, clinical staff only, providers only, or physicians only.

"I don't have answers, just a lot of questions. I don't think the journey has an end, but hopefully it's a starting point for a conversation," said Kressly.