We found that both teens and parents were enthusiastic about the use of a teen portal but had important concerns about confidentiality and the concern that parents would be left out of the loop. These findings are consistent with previous research, which has demonstrated teen interest in using the Internet for health issues and particularly for health issues related to sexuality and substance abuse.18
Prior research has also shown that both providers and patients view the patient portal in the healthcare system as an important means to enhance provider-patient communication.19,20
Finally the use of a Web-based patient portal has the added advantage of providing a better venue for teen self-disclosure of important but sensitive healthcare issues.21
With respect to specific features of the teen portal, both teens and parents most valued the possibility of easy access to reliable healthcare information. This finding echoes previous research that has shown that seeking health information is the most used feature of patient portals and of the Internet in general.22–25
The use of secure messaging and results reporting raised some concerns on the part of both parents and teens. A significant proportion of parents wanted to know about communication between their teen and a healthcare provider when it involved important healthcare issues. Teens, on the other hand, were skeptical that secure messaging with their provider would remain confidential. Both parents and teens expressed concerns that they may not know how to accurately interpret clinical results or take appropriate actions, leading to poor decision making or resulting in teens' not taking the appropriate action or ignoring the need to seek care.26
Both parents and teens were positive about using the teen portal for appointment making and appointment reminders. This, again, is consistent with previous research that has demonstrated the popularity of this feature of patient portals.27
Some parents, however, expressed concern that this capability meant they would not know about clinical appointments of their teens that concerned important healthcare problems.
Our findings suggest an interesting way to use the teen portal to enhance communication between parents and teens in the important area of teen confidentiality. Of interest is the suggestion by some teens and parents that the best solution to these differences would be negotiation between parents and teens as to what information should remain confidential between provider and teen and what information should be shared with parents. Several investigators have shown that parents can have a positive influence on decreasing teen adoption of high-risk behaviors and that the explicit expression of parental concerns can have a positive impact on teen behavior.28–33
Our results also show that both parents and teens felt that it was most appropriate for the primary care provider to bring up the issue of the teen portal with the parents and the teen. These findings suggest that the discussion of the teen portal with teens and parents by the provider could provide an important venue for discussion and negotiation of confidential health issues. Enlisting parents and teens in active discussion and negotiation offers an attractive alternative to mandating parental notification—a strategy that has been shown to discourage teens from using health services for sensitive issues.34,35
Any negotiation, however, would have to take place in the context of existing legislation protecting teen confidentiality and would have to consider the impact of the power asymmetry between parents and teens in the negotiating process.