During a breakout session at Texas HIMSS today, I attended “Reaching adolescents through electronic health portals: Lessons from the field” by Peggy B. Smith, MA, Ph.D.
While I normally lean towards the positive in providing insights from these breakout sessions, being a presenter is no easy feat, I must start with a couple of not so positive qualifiers. “Patient portal” was not really discussed during this session. Rather, “digital means of communication”, such as public websites and social media, is a more appropriate definition of the technologies discussed. Fair enough on the surface. However, not knowing the difference between public and secured technologies created a real problem when the presenter spoke of how HIPAA creates barriers to providing teens with health information via digital means. The patient portal, used thoughtfully, can assuage these privacy concerns. I feel that the presenter should have understood this. Her lack of knowledge on portal was amplified when I asked a question related to the timing of the data she collected in Approach 2, mentioned below, in relation to Meaningful Use Stage 2. She did not know what Meaningful Use Stage 2 was.
With that being said, I will carry on with insights from the session that I did find insightful. To present these in the correct context, I will mention that digital health in adolescents presents a number of quandaries for the healthcare provider. While most healthcare decisions and procedures can and do involve parental consent, not all can. I involved my colleague Dr. Marcie Stoshak-Chavez in defining what decisions and procedures do not involve parental consent. As she mentioned, although healthcare statutes vary by state, procedures for sexually transmitted diseases, pregnancy, contraception, psychiatric disorders, and drug or alcohol abuse typically do not involve parental consent and include additional privacy rules that exclude parents.
Since teens can and do use digital technology, and technology is often used by consumers to collect information because of the anonymity involved, it is quite apropos to discuss using digital health means, such as patient portal, when providing care for teens. This becomes a much more important conversation in those areas of care where parents should not, by law, have a seat at the table. Of course, it must be considered that oftentimes the devices teens use are not actually owned by them. This also must be considered.
Essentially, digital health provides the most obvious form of communication between provider and teen. However, there are many constraints. What follows are three areas of study that Peggy Smith provided:
Approach One: Web based platform for sexual health for at-risk youth
This method involved avatars named Tiff and Ty that were available for anonymous questions on sexual health via a clinical website (read: not portal). This research was a qualitative assessment that evaluated the anonymous questions that were submitted via the website. There were a total of 916 queries received. Six major question types were identified in order of frequency:
- Cost (Might seem surprising at first, but makes sense in decision making that does not include parents)
- STD testing
- Birth control
- Personal health concerns
- Parental consent and confidentiality
- Sexual health misconceptions
Some of the questions included, “Does it cost to have a regular check up and pap smear?” and “I was wondering if yall had HIVSTD testing available and how much it would cost?” and “Can I come in for birth control and will my insurance voer the cost for it?”
Approach Two: Evaluation of the adoption of electronic platforms by public health professionals
This method involved studying decision makers for technology platforms within the healthcare provider industry. This study wanted to understand to what extent public health professionals, the ones making the decisions, were familiar with electronic messaging and what their attitudes towards acceptance of these platforms were. This is the one where I must mention that the data was collected in 2011, which predates Meaningful Use Stage 2. I would guess that these figures would be much higher now, but it is interesting to see how failing we were in adoption of these technologies without the financial incentives. I must also point out that it is likely that the researchers did not describe these digital care methods in the context of portal, since they did not understand the difference between web and portal. If I were a decision maker, then that would have painted my answer in this case.
At the time of the study, only 37% of decisions makers stated that they currently had these systems in place. Only 15% of these decision makers stated that they had future plans for implementing these technologies. Recurrent themes in the research included a lack of confidence in the processes surrounding digital health, the depersonalization of healthcare, and the concerns for privacy. It is also interesting to note that there was a stated difference in age cohorts. Older decision makers were less likely to move forward in developing digital health infrastructure than their younger counterparts.
Approach Three: Global portal for information across continents
The method here was to use the upgraded website teenhealthclinic.org to provide a number of health education tools. These included a presence in social networking, a short message service, and health education webisodes. These webisodes targeted 16 and 17 year olds that were mostly Latino. They used the concept of “Edutainment” (education + entertainment) to provide information on topics such as HIV testing. Story ideas were based on real stories, contained entertainment value, provided context of audience lives, and focused on characters and their relationships.
There wasn’t much information provided on the impact of this approach other than to point to the “issues that HIPAA presented” when it came to public websites. Again, knowing the difference between public website and portal would be helpful here. Also, one information session participant commented that providing webisodes like this would have astronomical production costs.
Reaching Teens with Digital Health
Teen health education can oftentimes be a divisive topic, but the debates on this topic will not make these issues go away. In fact, it has been proven via cost data that limiting healthcare to teens generates a major drain on the healthcare system. With all of these facts in mind, do you believe technologies like patient portal can be used effectively in the area of teen health?