- Regulators should enforce stricter policies related to patient access to health information, according to a recent JAMA study that found many hospitals are not fulfilling federal or state regulations related to patient EHR and paper health records requests.
This finding comes as federal entities work to advance the aims of the MyHealthEData initiative, which is intended to improve EHR patient data access and give patients more control of their own health information.
Lye et al. conducted a cross-sectional study of medical records request processes conducted from August 1 to December 7, 2017 at 83 of the top-ranked hospitals in the country, according to the 2017-2016 US News & World Report Best Hospitals National Rankings.
Each hospital included in the study had independent medical records request processes and medical records departments. Researchers collected medical records release authorization forms from each participating hospital and conducted scripted interviews with each hospital’s medical records departments by phone in a single-blind, simulated patient experience.
The team gathered data about requestable patient information, formats of release, costs, and processing times.
Researchers made five attempts to reach each medical records department. Hospitals were considered unreachable on each attempt if the call was not answered, went to voice mail, or if the automated answering system did not offer an option to speak with a representative.
Researchers found only 53 percent of hospitals in the study provided patients the option on forms to obtain their entire health records.
“For individual categories of requestable information on the forms, as few as 9 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,” wrote researchers.
“Most hospitals (76 [92 percent]) provided the option of another category for requesting information not explicitly listed on the form,” the team added.
Meanwhile, all participating hospitals said they were able to release complete health records to patients when researchers contacted hospitals’ medical records departments by phone. This discrepancy between information provided online and information provided through medical records departments revealed a lack of transparency and consistency in medical records request processes.
“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,” clarified researchers.
Researchers also asked hospitals about which format they were able to use to release health information to patients. More hospitals stated patients could pick up their medical records in person rather than access their EHRs through online patient portals.
“Two hospitals reported not being able to release records electronically if the records were originally in a paper format,” researchers said.
The cost of accessing complete patient health records varied from hospital to hospital. Costs also varied depending on whether researchers used authorization forms to determine the cost of accessing medical records or requested cost information from hospitals via phone call.
Twenty-nine hospitals in the study disclosed costs on the authorization form or webpage researchers used to download the form.
“For a 200-page record, the cost of release ranged from $0.00 to $281.54, based on the 29 hospitals that disclosed costs,” the team wrote.
Meanwhile, the cost of a 200-page record ranged from free of charge to $541.50 among hospitals who disclosed health records release costs over the phone.
Of the 82 hospitals that communicated costs over the phone, 59 percent required that patients pay more than the federally-recommended flat rate of $6.50 for patient EHRs.
“For electronic formats of release, some hospitals reported charging $6.50, and some reported no charge for records released via an online patient portal,” explained researchers. “However, other hospitals charged the same fees for electronic formats and paper formats.”
Finally, researchers investigated processing times for medical records release.
Seventy-one hospitals in the study provided average times of release for paper health records. Ten hospitals provided a maximum time of release, and two hospitals were unable to offer an average or maximum time of release.
Among hospitals that provided average times of release, 21 percent reported average times of less than seven days, 25 percent said the process would take seven to ten days, and 31 percent said 11 to 20 days.
Five percent said the process would take 21 to 30 days, while 4 percent said the medical records request process would take more than 30 days to complete.
“In general, most hospitals were able to release records in electronic format in a shorter time frame than records in paper format,” noted researchers.
The amount of time it actually took hospitals to release patient health record ranged from a same-day to 60 days.
“Of the 81 hospitals that responded with times of release, 7 had ranges extending beyond their state’s requirement before applying the single 30-day extension granted by HIPAA,” stated researchers.
Ultimately, researchers determined there was a lack of transparency in the medical records request process.
“Using the predetermined script for the telephone calls, we were able to clarify what records could be requested and how they can be requested,” wrote researchers. “However, patients filling out authorization forms alone are often not presented with an accurate list of the records that they can request.”
Hospitals in the study also failed to consistently and clearly display information about the costs associated with accessing patient health records.
The amount of time it took some hospitals to process medical request also sometimes exceeded state and federal requirements.
“Hospitals that provided mean processing times did not provide enough information to fully assess whether they were compliant with state requirements,” wrote researchers.
Overall, researchers stated requesting patient EHRs and paper health records is a complicated, cumbersome process for patients despite state and federal efforts to streamline the process.
“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,” researchers concluded.