Although federal law has long promoted patients’ access to their protected health information, a recent study of 83 hospitals has revealed that there was noncompliance with federal regulations for formats of release and state regulations for request processing times.
The research, published recently in JAMA, also found that there was discordance between information provided on medical records release authorization forms and that obtained directly from medical records departments regarding the medical records request processes.
The Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives patients the right of access to their protected health information. Per federal regulation, medical record requests must be fulfilled within 30 days of receipt (with the possibility of a single 30-day extension) in the format requested by the patient if the records are readily producible in that format.
Despite HIPAA and the fact that electronic health records (EHRs) are much more widespread now than in years past, patients may not be able to easily request, receive, and manage their medical records. Under guidance from the U.S. Department of Health and Human Services, hospitals are permitted to impose a reasonable cost-based fee for the release of medical records, but costs still remain high. What’s more, many hospitals add procedural obstacles that can limit patient access, the researchers noted.
To this point, a GAO (Government Accountability Office) report earlier this year also found some troubling trends regarding patient access to medical records. The GAO analyzed four states, finding one instance in which patients paid more than $500 for a single medical record request, and another in which one patient was charged $148 for a PDF version of her medical record.
For this latest study, researchers collected both medical records release authorization forms from each hospital, and subsequently telephoned each hospital’s medical records department to collect data.
Among the 83 hospitals, 44 (53 percent) provided patients the option on the forms to acquire their entire medical record. For individual categories of “requestable” information on the forms, as few as nine hospitals (11 percent) provided the option of selecting release of physician orders and as many as 73 hospitals (88 percent) provided the option of selecting release of laboratory results. Most hospitals (92 percent) provided the option of an “other” category for requesting information not explicitly listed on the form.
Among the telephone calls made, all the hospitals said they were able to release entire medical records to patients. When asked if any information would be withheld with a request of an entire medical record, two hospitals disclosed that nursing notes would not be released unless they were specifically requested. However, just 25 percent of the hospitals who were called said they were able to release information onto patient portals. All hospitals stated in telephone calls and on the forms that they could release information via mail.
Regarding cost, on the authorization forms, 35 percent of hospitals disclosed exact costs for releasing medical records, 22 percent said they would charge patients without specifying a cost, and 36 percent did not specify anything about fees. For a 200-page record, the cost of release ranged from $0.00 to $281.54, based on the 29 hospitals that disclosed costs.
Among the telephone calls, 82 out of 83 hospitals disclosed costs for paper formats of release. For a 200-page record, the cost of release as communicated in telephone calls ranged from $0.00 to $541.50. And of the 82 hospitals that disclosed costs, 48 hospitals (59 percent) stated costs of release above the federal recommendation of a $6.50 flat fee for electronically maintained records.
Finally, for processing times for medical records release, of the 71 hospitals that provided mean times of release when called, 21 percent reported mean times of less than 7 days; 25 percent in seven to 10 days; 31 percent in 11 to 20 days; 5 percent in 21 to 30 days; and 3 4 percent in more than 30 days. In general, most hospitals were able to release records in electronic format in a shorter time frame than records in paper format.
Of the hospitals that responded with times of release, seven had ranges extending beyond their state’s requirement before applying the single 30-day extension granted by HIPAA.
The researchers concluded, “Requesting medical records remains a complicated and burdensome process for patients despite policy efforts and regulation to make medical records more readily available to patients. Our results revealed inconsistencies in information provided by medical records authorization forms and by medical records departments in select U.S. hospitals, as well as potentially unaffordable costs and processing times that were not compliant with federal regulations. As legislation, including the recent 21st Century Cures Act, and government-wide initiatives like MyHealthEData continue to stipulate improvements in patient access to medical records, attention to the most obvious barriers should be paramount.”