Tethered EHR/Patient Portal for the Child and Adolescent Patient

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Use of the patient portal in a pediatric practice brings a unique set of challenges when compared with use in an adult patient population.

Patient Portal (tethered EHR) for the Child and Adolescent Patient

During the years before the child is an adult, it is possible that a parent or guardian may want to limit a child’s access to some health information, such as family history, potential genetic disorders, etc. Once a child is old enough to want to look at the information independently, it can be a challenge to restrict what information flows to the portal.

An even bigger challenge is use of the patient portal during the adolescent years. During the adolescent years, a parent may still chose to limit information from the child, but a new set of laws come in to effect that may limit the parent’s ability to see medical information about the teen. In some situations, an adolescent may assert independence and chose not to allow a parent to access some or all of their medical records.

The most notable of these situations are:

  1. Certain health care interventions such as reproductive health, sexually transmitted disease testing and treatment, psychiatric services, and substance abuse evaluation/treatment can be confidential and must not be disclosed to a parent/guardian without the teen’s consent.
  2. Living situation such as marital status, emancipation due to childbirth, military service, or financial independence may make the child truly independent, and the teen would need to consent before any records could be released to parent.

Laws regarding these issues vary dramatically between states, making the issue even more confusing for health care organizations. For instance, the age at which a person is considered an adult (age of majority) varies greatly between states. For most states, it is 18, but Alabama and Nebraska set 19 as the age of majority, yet Alabama allows health care consent at age 14. In North Dakota, the age of consent is 12. Laws regarding consent for abortion and reproductive care vary even more dramatically. This variation in law presents an additional challenge for large organizations that span many states, or in situations where the child and parent may reside in different states.


  1. Bourgeois FC, Taylor PL, Emans SJ, Nigrin DJ, Mandl KD. Whose Personal Control? Creating Private, Personally Controlled Health Records for Pediatric and Adolescent Patients. J Am Med Inform Assoc 2008 Nov-Dec; 15(6): 737-43.
  2. Ford C, English A, Sigman G. Confidential Health Care for Adolescents: Position Paper from the Society for Adolescent Medicine. J Adolesc Health 2004 Aug; 35(2): 160-7.

Submitted by Heidi Twedt