Guidelines evolve on child health records | Health Beat

If you’re the parent or guardian of a child who is a Spectrum Health patient, your child’s 12th birthday marks a milestone you might not be aware of.

That’s the day your proxy access to your child’s medical information—viewable in your Spectrum Health MyChart patient portal—switches from full to partial. That means you can no longer see things like a doctor’s notes about your child’s office visit.

Parents don’t always welcome this limitation in access.

The Spectrum Health policy on adolescent proxy access follows Michigan’s privacy laws, Amee Sleesman-Krussell, system architect for MyChart at Spectrum Health, said.

“For parents, this is hard because 12 years old is young. However, under state law, at 12 years old they have the right to privacy for certain health care services,” Sleesman-Krussell said. “We need to walk that fine line.”

What do state privacy laws cover?

Michigan law gives adolescents the right to confidential care without a parent or guardian’s permission in certain areas, including care for sexual and reproductive health, mental health and substance use disorders.

Lisa Lowery, MD, who leads the Adolescent and Young Adult Medicine Clinic at Spectrum Health Helen DeVos Children’s Hospital, provides primary care for teens and young adults with a range of health care needs, including these confidential areas.

“It really allows patients to feel like they can have an open conversation with you,” Dr. Lowery said. “It allows teenagers to have some autonomy and agency around their health care.”

This right to privacy is particularly important for teens who don’t feel comfortable sharing their medical information.

“There may be times when they don’t want to tell their parent that they’re sexually active and they want to access birth control or they want to be tested for a sexually transmitted infection,” Dr. Lowery said.

“I would love for our patients to be able to have full conversations with their parents,” she said. “However, there are some teens who feel like, ‘At this point, for whatever reason, I can’t have these conversations with my parent.’”

What does MyChart proxy access allow after age 12?

When children turn 12, most of their medical records—including diagnoses, medications, after-visit summaries and lab results—no longer show up in the MyChart account of their parent or guardian.

But MyChart proxies can still perform some online activities for their adolescents.

Specifically, parent or guardian proxies can:

• Send messages to the child’s providers
• See upcoming appointments
• Schedule appointments
• View and print immunization records
• View and update account information, such as address and phone number

The ability to communicate with doctors via MyChart messaging reassures parents and guardians, according to Sarah Lickiss, LMSW, a clinical social worker in the Adolescent and Young Adult Medicine Clinic.

“Once parents see that, they realize that they’re not being completely excluded from their child’s health care, but that it’s a way for us to honor the laws that are in place,” Lickiss said.

“Once they get their access, they realize that they’re fine. They were just afraid because they care about their child’s health and they want them to be safe. We do, too. We all have the same goals.”

Should teens set up their own MyChart account?

After their 12th birthday, Spectrum Health patients can set up their own account, linked to their personal email address.

This gives them full access to their medical records in an account that stays with them into adulthood.

Though MyChart can be tricky for younger teens to navigate, it provides a good way for them to become engaged in their health care as they get older, providers say.

“In adolescent medicine, our goal is that by the time we transition you to adult care, you can do this by yourself. And so I do think there’s a beautiful benefit from it,” Lickiss said. “A lot of the older teens get excited to have their own chart because they get to own this.”

A teen can set up a MyChart account during an office visit or by contacting MyChart customer support at 877-308-5083.

If a parent or guardian doesn’t already have proxy access, the teen can opt to grant that limited level of access—called “standard access”—when they set up the account.

What else should children and parents know?

First, teens who want help managing their medical appointments can invite a parent to sit down and navigate MyChart with them as they learn how it works.

Second, teens who want to protect their information should understand that although privacy is protected, it isn’t guaranteed.

For example, an insurance company’s explanation of benefits could expose treatment information that MyChart doesn’t reveal.

And though providers respect teen privacy as a rule, they use their clinical judgment where patient safety is concerned.

The law still allows parents to obtain child health information when it relates to suicide, acute safety concerns or child abuse or neglect.

“Those things generally won’t remain confidential in a visit for anyone under the age of 18,” Lickiss said.

When the patient turns 18, the parent or guardian’s MyChart proxy access turns off completely.

If they don’t already have a MyChart account of their own by then, the young adult should set one up, providers said. They can add another adult as a proxy if they want to, from within their account.

What about adolescents who can’t manage their own account?

In special situations—patients with cognitive challenges or complex medical needs—proxies can request full MyChart access. This is known as enhanced access.

“There are cases where, truly, a parent needs to have full access. And we leave it up to our providers to have that discussion and make that determination,” Sleesman-Krussell said.

Ideally, providers, adolescents and parents work together to reach the best outcomes, Lickiss said.

“My understanding has always been to honor adolescent health rights without excluding parents.”