The federal government approved the 21st Century Cares Act in 2016 - but its enforcement started approximately one year ago. The main purpose of this Act requires healthcare providers to give patients access to all their health information in the electronic medical record without delay and without charge. It allows the patient (or the patient’s representative – parent or guardian) to see his/her entire medical record.
What is contained in the medical record is more than what many people realize. Routinely, the patient knows that it includes office visit notes, physical exams, lab tests, and diagnoses. However, there is much information - social history, family dynamics history, social determinants of health – poverty, adequate food sources for example, sexual history and orientation of the patient, mental health history, to name a few – that are also part of the medical record. This type of information is required by the insurance industry and governmental agencies.
How does this impact you and your children? Whether or not you are aware of this, the State of Illinois views “minors” (age 12 years – 18 years of age) as having patient rights. That is, there are certain medical conditions that they may seek treatment for and receive. If one of these conditions is present, medical care for them is confidential and only with their permission can we share it with you, their parent/guardian. So, when caring for this age group (age 12 years – 18 years), we have the unique situation of having TWO clients for each visit – parent and adolescent. Each gets to exercise control over certain types of data – the adolescent for treatment of certain conditions (reproductive health, substance use, mental health). We are left with the task of determining which data elements require consent of the adolescent to release (or view in the chart) and which can be released by consent of the parent.
In the State of Illinois (each state has their own rules), a minor (age less than 18 years) can consent for his/her own treatment if:
· They are married.
· They are pregnant.
· They are a parent.
· They are emancipated.
Minors (12 years - 18 years of age), can ask/consent to treatment for:
· Sexually transmitted diseases/reproductive health (birth control)
· Sexual abuse
· Drug and alcohol abuse
· Mental health visits (up to 5 visits of 45 minutes each)
For any information pertaining to any of the above conditions, the minor must give written permission/consent to the treating health facility before any information can be shared with a parent or guardian. The minor can expressively grant release of only certain mental health information to whom he/she wishes.
We as healthcare providers are required to abide by these state statutes and federal laws. When a “minor” patient requests care in one of the above situations, we will:
· Evaluate and make recommendations to the patient.
· Strongly encourage the patient to discuss the situation with his/her parent/guardian.
· Ask the patient if they would want help from us to discuss the situation with his/her parent/guardian.
· When a situation exists in which discussing the condition with the parent would be detrimental to the patient, we seek help for the minor from other individuals designated by the patient or a social agency.
When documenting an encounter (office visit) with “minors” that involves one of the above conditions, the confidential documented information will be placed under protected areas. The parent or guardian will not be able to see that information in the chart unless the “minor” has given permission for it to be shared. Similarly, if a parent receives a bill from us and sees that a visit occurred, no one from our office will be able to discuss anything about the visit without permission from the “minor”.
We recognize that some of this information could be “eye opening” to some parents; to help minimize these situations, we encourage parents to:
· Have open dialogue with your children in regards to the above situations in which ‘Minors” can maintain confidential information
· Consider writing to your representatives and senators both at a state and federal level to discuss your opinions and feelings surrounding these issues.
Between the 21 Century Cares Act and the rights of “minors” and their confidentiality, we as health care providers are caught in the middle of this sometimes-uneasy environment. The state and federal governments have made the statutes and laws – but they have not provided any assistance as to how to seamlessly make these work in unison.
Please bear with us as we move forward this year – attempting to do our best in keeping everyone informed but yet protecting the rights of our patients.
Starting May 15, 2023, we will be requiring all 12-year-old patients and older to complete a form designating their choice to whom information can be released on their behalf. This is to allow us to be compliant with all current State of Illinois statutes and federal laws pertaining to our patients.
We thank you for your understanding and cooperation with this new policy.