By this point, few would argue that patients are unlikely to be engaged with their medical care if they don’t have free, unfettered access to the medical records. However, unfortunately, research continues to suggest that providers are struggling to meet these goals — and from my point of view, shows signs that they don’t take the entire process that seriously.
Most recently a new study found that not only may hospitals be failing to meet state and federal rules on patient medical record sharing, they may not even be communicating about their own policies consistently. As a patient with complex medical needs, I found this troubling, though sadly, not so surprising given my past experiences.
The study, which appeared in JAMA Network Open, looked at the way in which 83 US hospitals handled medical record requests by patients. The research team conducted the requests between August 1 and December 7, 2017, tracking what medical information was made requestable, what formats of release were available, costs to receive the information and request processing times. Researchers reviewed hospital processes using medical record release authorization forms and telephone calls with medical records departments.
After analyzing their data, the researchers concluded at least some hospitals weren’t complying with regulations regarding medical information request processing times. Of the 81 hospitals that responded to the researchers with mean times of release for records, seven had ranges extending beyond state requirements before applying the single 30-day extension granted by HIPAA.
In addition, they found that patients obtained different information regarding medical records request processes when they filled out form versus when they communicated directly with medical records departments. For example, just 53% of hospitals gave patients the option to request the entire medical record on their record request forms, while when the medical record department was contacted, all the hospitals said they were able to and release an entire medical record to patients.
Perhaps offering some insight into why patient portals aren’t as muscular as they could be, just 25% of hospital medical record departments said via phone that they were able to release records to online patient portals, and less than half (40%) shared this detail this on their forms.
Another issue highlighted by the study was that the hospitals studied seem to be vague about the costs patients faced in receiving records. Apparently, 22% of hospitals disclosed they would charge patients for such records but did not specify cost, and 43% didn’t specify that there would be a fee.
Having inadvertently walked into a cost backsaw once or twice in my pre-HIT days, I can’t stress enough how disheartening unexpected records fees can be for patients. After all, in some cases patients don’t get the care they need if they don’t have up-to-date-records, and until we have a completely universal interoperability scheme in place patients are on the hook to make this happen.
Getting the records seems to have been pricey. All but one of the hospitals were able to quote the cost for receiving records on paper, at prices which began at zero but went as high as $541.50 for a 200-page record. On the digital side, 59% of the hospital stated a cost of release above the federally-recommended $6.50 flat fee per page for electronically-maintained records.
As the study authors note, it would be helpful if federal regulators keep their eye on issues related to patient medical record access, which is more costly, confusing and time-consuming than it might appear at first glance. In the meantime, hospitals might consider doing a self-audit to see if they are offering patients consistent information on the process when we ask for badly-needed medical data.
