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Adolescents and Patient Portal Secure Messaging: Who is Using MyChart?

June 5, 2023

In a recently released issue of Pediatrics, Dr. Andrea Hoopes and colleagues from Kaiser Permanente Washington examined adolescent use of secure patient portal messaging over the period 2019-2022 (10.1542/peds.2022-060271). The authors’ main research aim was to compare the characteristics of those adolescents who used patient portal secure messaging in the Kaiser health system as compared to those who did not. In adults, patient-provider secure messaging has been shown to improve patient satisfaction, with indications that adherence and care measures may also be improved.1,2 One of the first steps towards recognizing any barriers to engagement is understanding which adolescents are using secure patient portal messaging since increased engagement has potential to improve the health of adolescents as it does for adults.

Beginning in January 2019, youth ages 13-17 years receiving health care at any of Kaiser Permanente Washington facilities became eligible for a “teen account,” with their parent/guardian eligible for a “teen proxy account.” Confidentiality was aligned with state minor consent laws, and further protections included inability for teens or teen proxies to view or initiate messages to providers in mental health, obstetrics/gynecology, and adolescent medicine (though replies to provider messages could be accessed). MyChart (the online portal system) registration for teens evolved from an initial requirement to present in-person for a password to much simplified access with phone-based activation. Patients at Kaiser Permanente between the ages of 13-17 years with 3 months of continuous Kaiser enrollment and at least one clinical visit in the past 36 months (or empanelment with a Kaiser provider) were eligible and monthly data use data were gathered. The study impressively enrolled 37,818 unique individuals with 667,678 months of portal use observation.

Adolescent secure messaging patient portal use increased from <1% (2019) to 6% (2020) to 8% (2021). Being female, privately insured, and transgender or gender diverse increased chances of portal use, as did each additional year of age; those who identified as having more than one race had higher rates of portal use than any specific racial or ethnic group. These fascinating findings, with more to uncover in the article, suggest that research is needed to best understand not only what drives use but what social or other factors may serve as barriers to use.  Finding ways to engage and empower adolescents with respect to their own health care will be a win-win: adolescents can achieve current health goals, and also begin to prepare for a transition to managing their own health care before needing to “go live” at age 18 years. I hope this article intrigues you as much as it did me!


  1. Antonio MG, Petrovskaya O, Lau F. The State of Evidence in Patient Portals: Umbrella Review. J 352 Med Internet Res. Nov 11 2020;22(11):e23851. doi:10.2196/238512.
  2. Chung S, Panattoni L, Chi J, Palaniappan L. Can Secure Patient-Provider Messaging Improve Diabetes Care? Diabetes Care. 2017 Oct;40(10):1342-1348. doi: 10.2337/dc17-0140. Epub 2017 Aug 14. PMID: 28807977
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