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Pediatrics. 2018 Jun;141(6). pii: e20172745. doi: 10.1542/peds.2017-2745. Epub 2018 May 18.

Ethical Challenges Raised by OpenNotes for Pediatric and Adolescent Patients.

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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.


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.

[Indexed for MEDLINE]

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