Poor Hospital Compliance With Patient Record Requests 

Diana Swift

October 05, 2018

US hospitals continue to place cost and processing obstacles in the way of patients requesting their personal medical records, according to a study published online October 5 in JAMA Network Open.

The study highlights the need for tougher enforcement of state and federal policies on the accessibility of protected health information to ensure a smooth, timely, and affordable process for patients, write Carolyn T. Lye, BA, a medical student at Yale School of Medicine, New Haven, Connecticut, and colleagues.

In its survey of 83 top hospitals across 29 states, the study reports that many facilities do not comply with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This federal law guarantees that patients have access to their protected health information within 30 days in their preferred format and at a reasonable charge.

The investigators evaluated adherence to HIPPA guidelines through prescripted telephone interviews conducted with one person at each of the hospitals' medical records departments from August 1 to December 7, 2017. The elite hospitals were ranked as the top 20 for each of the 16 adult specialties in the 2016-2017 US News & World Report's Best Hospitals National Ranking.

The survey found contradictory information about records entitlement, varying release times, and higher-than-recommended fees.

"There were overwhelming inconsistencies in information relayed to patients regarding the personal health information they are allowed to request, as well as the formats and costs of release, both within institutions and across institutions," Lye said in a JAMA news release. "We also found considerable noncompliance with state and federal regulations and recommendations with respect to the costs and processing times associated with providing access to medical records."

In 2017, a report from the US Department Health and Human Services' Office of the National Coordinator for Health Information Technology revealed barriers to patients' obtaining their medical records.

Although all 83 facilities in the study communicated by telephone that they could release a patient's entire medical record, only 53% explicitly stated this on their paper authorization forms, and only 11% stated on forms that they could release physicians' orders.

Discrepancies about available formats emerged in telephone statements vs statements on forms, pointing to noncompliance with federal regulations that require release in a patient's preferred format. There was a phone-vs-form discordance of 83% vs 48% on the option of picking up the records in person and of 24% vs 17% for transmission by fax. For other release options, the phone-form discrepancies were 47% vs 33% for email, 66% vs 42% for CDs, and 25% vs 40% for online patient portals. There was no discrepancy for release by regular mail (100% both).

As for fees, 43% of hospitals provided no fee schedule on the authorization form or on the webpage for downloading the form. Whereas some hospitals charged no processing fees, 48 (59%) charged costs higher than the Office for Civil Rights recommendation of a flat fee of $6.50 for electronically maintained records — in one case charging $541.50 for a 200-page record.

In the telephone interviews, 82 hospitals disclosed costs for a paper release, and one was unable to comment because costs were calculated by an external party. Of the 29 hospitals that disclosed fees on authorization forms, nine (31%) charged the same fees as those disclosed by telephone, 10 (34%) charged less, three (10%) charged more, and seven (24%) charged nothing.

On the issue of timing, 71 hospitals provided mean times of release for paper records in telephone interviews, with the time ranging from same day to 60 days. Of the hospitals that responded with processing times, seven centers were not compliant with government requirements.

Ten institutions gave a maximum time of release, whereas two could not specify either a mean or maximum. Of those supplying processing time information, 17 (21%) reported mean times of fewer than 7 days, 21 (25%) of 7 to 10 days, 26 (31%) of 11 to 20 days, four (5%) in 21 to 30 days, and three (4%) of more than 30 days. Almost 15% were "unable to say." Release times were generally shorter for electronic records than for paper records.

"As legislation, including the recent 21st Century Cures Act and government-wide initiatives such as MyHealthEData continue to stipulate improvements in patient access to medical records, attention to the most obvious barriers should be paramount," the authors write.

"We are also in an era in which patients are participants in their own health care. Inhibiting access for patients to their own medical records with complicated, lengthy, and costly request processes prevents patients from obtaining information that they may need to better understand their medical conditions and communicate with their physicians," Lye added in the news release.

The authors' relevant financial relationships are listed in the original article.

JAMA Network Open. Published online October 5, 2018. Full text

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