P2.071: Implementation of Sensitive Medication Filtering at a Children's Hospital

Background: Sharing electronic health information with patients and their families is both clinically important and legally mandated. Concurrently, adolescents have legal protections, varying by state, for confidential care related to reproductive health, mental health and substance use. Balancing the need to share information with the importance of respecting adolescent privacy is challenging, leading some organizations to limit information sharing broadly. This may include limiting access to medication lists and refill functionality through the patient portal. Subsequently, families have created workarounds to access and manage their adolescent’s medication(s) which leads to increased provider messaging and higher inbasket burden.

Project Description: With the goal of improving proxy access to medication lists through the portal (and the associated functionality such as medication refills), Stanford Children’s embarked on enabling sensitive medication functionality in the electronic health record (EHR) that allows providers to indicate that specific medications should not be made visible to proxies through the portal without the patient’s permission. A stakeholder committee was formed with representatives from clinical informatics, nursing, pharmacy, adolescent medicine, as well as operational leaders in both inpatient and ambulatory settings. Categorization of medications to be labeled as sensitive was grounded in California sensitive service laws, and a series of sensitive medication groupers was developed. A phased approach was used to minimize potential for inadvertent release of potentially-sensitive medications. Optimization of after visit summaries for adolescents was performed. Educational interventions were developed for pharmacists, nurses, and providers via multiple outreach modalities.

Discussion: With the release of sensitive medication functionality, there are new opportunities to allow sharing of non-sensitive medications with proxies of adolescent patients. With the implementation of this functionality, we were able to share medication lists an additional with 85,777 patients and proxies of adolescent patients at Stanford Children’s. There was a 47% increase in medication refill requests through the portal after go-live. To date, there have been no reports of confidentiality breaches for adolescent patients as a result of implementing this functionality.

Conclusion: Implementing sensitive medication filtering for adolescents was feasible, allowed for sharing of critical health information with patients and their families and resulted in a shift to more appropriate workflows for requesting prescription renewals. Future advocacy is needed around sharing this sensitive medication flag through health information exchanges to ensure confidentiality is protected across the healthcare delivery system.