Information Blocking: Adolescent Confidentiality Is Collateral Damage

Margaret Thew, APNP


November 17, 2020

On April 4, 2021, a rule implementing the federal regulations of the Information Blocking 21st Century Cures Act will be enacted. This Act furthers the seamless release of medical records to promote improved outcomes, access to medical information, and transparency of costs. These regulations, although important, may impact the ability to offer confidentiality to adolescents seeking care for sensitive issues. Each state will need to be thoughtful balancing the action or inaction of allowing access to confidential or sensitive progress notes, as interference with access may be considered information blocking and subject to penalties and fines.

With adolescent confidential notes, protection rules may not apply under the information blocking regulations. These regulations will release progress notes, imaging narratives, procedure notes, and labs to parents via their EHR portals. The release of information is not limited, and both inpatient and outpatient records will be released. These regulations are written for adults with the assumption that all information is released to the individual receiving the care and shared with outside providers.

Unfortunately, the rules do not take into consideration adolescent confidential care. There are eight rules for the exception of releasing information, but it may be a stretch to place adolescent confidential progress notes under any of these eight exceptions. These exceptions are ambiguous and open to interpretation yet require specific documentation as to the limitation of access. Exceptions are prevention of harm; privacy conflicts; the security of the electronic health information; infeasibility, which includes challenges limiting the ability to comply; Health IT performance; content and manner; fees; and licensing.

Thew is medical director of the department of adolescent medicine at Children’s Wisconsin in Milwaukee. She is a member of the Pediatric News editorial advisory board. She had no relevant financial disclosures.

This article originally appeared on, part of the Medscape Professional Network.


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