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.
Assessment of US Hospital Compliance with Regulations for Patients’ Requests for Medical Records.
CMS: MyHealthEData Initiative to Put Patients at the Center of the US Healthcare System
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