PURPOSE: United States healthcare systems have enacted varied adolescent online patient portal policies. No prior work has established whether these policies are acceptable to adolescents and parents. METHODS: Mixed-method Delphi approach with 18 parents and 18 adolescents with and without chronic illness. We presented 19 policies related to (1) who can access different types of information through the portal
(2) timing of results release
and (3) portal messaging policies, such as whether individuals are charged for portal messages. Panelists voted on whether they "supported," "could live with," or "opposed" each policy. RESULTS: Thirty-six panelists completed surveys with no attrition. For access-related policies, panelists opposed prohibiting parent or adolescent access, and they accepted policies that provided transparent access to sensitive and nonsensitive information for parents and adolescents. Panelists failed to reach consensus about whether adolescents should have the granular ability to determine which parts of the medical record their parents can see. For policies related to timing of release, panelists found either immediate or delayed access to results to be acceptable, although more panelists supported immediate access. For portal messaging policies, panelists supported the ability of parents and adolescents to send messages and opposed being charged for portal messages. Panelists found it acceptable for adolescents to see messages written by their parents, but failed to reach consensus on whether parents should see messages written by adolescents. DISCUSSION: Some healthcare systems have implemented adolescent portal policies that panelists opposed or found concerning. Hospital leaders should consider these data as they re-evaluate institutional policies.