Division of General Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Department of Medicine, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Pediatrics. 2018 Jun;141(6). doi: 10.1542/peds.2017-2745. Epub 2018 May 18.
Sharing clinic notes online with patients and parents may yield many potential benefits to patients and providers alike, but the unprecedented transparency and accessibility to notes afforded by patient portals has also raised a number of unique ethical and legal concerns. As the movement toward transparent notes (OpenNotes) grows, clinicians and health care organizations caring for pediatric and adolescent patients wrestle with how to document confidential and sensitive information, including issues such as reproductive health, misattributed paternity, or provider and parent disagreements. With OpenNotes now reaching >21 000 000 US patients, pediatricians continue to query best portal practices. In this Ethics Rounds, we discuss 3 illustrative cases highlighting common pediatric OpenNotes concerns and provide guidance for organizations and clinicians regarding documentation practices and patient portal policies to promote patient engagement and information transparency while upholding patient and parent confidentiality and the patient- and/or parent-provider relationship.
在线与患者和家长分享临床笔记可能会给患者和提供者带来许多潜在的好处，但患者门户提供的前所未有的笔记透明度和可及性也引发了一些独特的伦理和法律问题。随着透明化笔记（OpenNotes）的发展，照顾儿科和青少年患者的临床医生和医疗保健组织正在努力解决如何记录机密和敏感信息的问题，包括生殖健康、错误归因的父亲身份或提供者和家长之间的分歧等问题。随着 OpenNotes 现在覆盖超过 2100 万美国患者，儿科医生继续询问最佳门户实践。在本次伦理轮值中，我们讨论了 3 个具有代表性的案例，强调了常见的儿科 OpenNotes 关注点，并为组织和临床医生提供了有关文档实践和患者门户政策的指导，以在维护患者和家长的机密性以及患者和/或家长与提供者关系的同时，促进患者的参与和信息透明度。
