What great questions! Let me take them in reverse order. I think your second idea is an excellent one, and one I will try with selected patients. For us, the potential issue is that parents can also see the emails between me and the teen, so it would be useful now to help teens who are in good communication with their parents. It would be less helpful, I think, where the issues are confidential, or where the teen is unwilling to share with the parent. But there is no reason not to use something that could help some teens, just because it might not help them all!

I think the suggestion to “send me a hello” is a great one especially for teens, but also for anyone thinking about using online services. Teens especially need an invitation, I think, and “send me a hello” lets them log in, and even check out what the site offers, without having to have a medical issue to discuss.

At KP our sign up process has been arduous–you register on line, and you get a temporary password in the mail 7-10 days later. If you don’t use it within 90 days, it expires, and you have to start over. There are really valid security reasons for doing it this way, but we know that something like 40% of people who signed up never actually logged in. In the last year, we have trained people at every office to be able to register the member right in the office and give them the temporary password–much better! But they still have to go to some central site in the building. Doing online authentication so folks can register and receive a password right away sounds like a simple concept, but not when you have to be certain the person is really who they say they are to protect their personal information. Nonetheless, we are finally able to do that starting in late February.

Why am I torturing you with that detail? If you were a teen, would you go through all that? I am hoping to get my colleagues to agree to try out a streamlined solution–we invite the teen, walk them to one of our staff who can create their password, then walk them to a computer where they can log in, create their permanent password, and even send that hello message. At the same time, we could have the staff person also activate the parent’s proxy access, so they can also be part of the conversation right away.

I am not sure how long it will take to do all this, assuming I can convince my office colleagues and staff it is worth while. But I hope to get it done soon. I don’t think that with teens you can just build it and expect them to use it. We need to make it easy, and really inviting. We’ll see!

I was going to ask you about this in e-mail, but this proved to be a great forum….it’s about disparities and teens.

There is a lot of effort in health care to have teens come in for care, and when they come in, to address concerns and risks that may shape their health for the rest of their lives.

With that in mind, I wanted to ask - what do you think about these tools as a method of reducing disparities -

1. By regularly advising teens to message you after they see you - like saying, “Just send me a message with your questions. If you don’t have a question, just send me a hello.” - as a way to open the door to a conversation that may not have happened in person.

2. By increasing the frequency of messaging for teens that you think may be at risk - something like, “How about sending me a message once a month or at the end of your next term telling me how school is going.”

Other ideas? Or ideas that you might tailor to patients from different home, cultural, economic backgrounds, to support great health for the diversity of our patients?

Thanks again for leading the way! These are things we can’t even try yet….