Institutional Barriers Faced by Patients Accessing Their Protected Health Information
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Recall that patients face institutional barriers to accessing their PHI 2. Describe how access to PHI is governed by several state and federal regulations
Estimated time to complete activity: 0.25 hours
Ashley Comfort, MD, FACOG is the Director of Medical Content, ObG Project.
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Ashley Comfort, MD, has a financial interest in Pfizer and has no other conflicts of interest to disclose.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 3 2018 through Dec 3 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Healthcare professionals often need patient records from previous hospital stays to provide optimal care. Obtaining those files is a task that ultimately falls on patients, and can often be a struggle. Two laws place on healthcare providers the legal obligation to safeguard the privacy and security of health information, and to provide patients with access to their protected health information (PHI). While the Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national set of security standards for protecting certain health information that is held or transferred in electronic form, it is not the primary ruling legislation for the release of information to patients. The Health Information Technology for Economic and Clinical Health Act (HITECH) is part of the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA does contain incentives related to health care information technology in general (e.g. creation of a national health care infrastructure) and the acceleration of the adoption of electronic health record (EHR) systems among providers. In March 2018, the MyHealthEData initiative was announced as a plan to empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all while keeping that information safe and secure. However, the October 2018 survey report in JAMA Open highlights the variable and inaccurate information provided to patients when requesting their medical records. It also reveals noncompliance with prevailing federal law governing requests for medical records. The survey covered 83 top ranked hospitals across the United States.
First, requests for medical records are required to be fulfilled in 30 days with a single extension of 30 days permitted. The majority of institutions met the 30-day deadline. It appears that electronic format was quicker than paper. However, a technological void still exists with many patients not having computer access or being computer savvy.
Second, the cost to obtain medical records is established by both state law and federal law with conflicts that are not always easily resolved. The costs range from free to nearly $300 for a 200-page record. Electronic format has a fee of $6.50, but some institutions still charged the higher paper rate even when the records were provided in electronic format. Reaching a representative by telephone to discuss costs met with either no response, inaccurate information, or accurate information after navigating through the telephone maze.
Third, about half the hospitals gave patients the option of choosing entire medical record on its paper authorization form. A small number allowed for particular categories of information such as laboratory results or physician orders. Most authorization forms provided for “other” information to be requested.
Among the telephone calls, 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, 2 hospitals disclosed that nursing notes would not be released unless they were specifically requested. One hospital stated that selecting medical record abstract on the form would result in release of the entire medical record, whereas other hospitals communicated that an abbreviated medical record would be released.
In summary, the study demonstrated that patients face unnecessary roadblocks when requesting their PHI from hospitals, including exorbitant costs and undue delay despite federal regulations. The authors of the study conclude that “attention to the most obvious barriers should be paramount” with the goal of eliminating hurdles and noncompliance.
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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