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Process for Requesting Medical Records Remains Burdensome

Laura Joszt
Although patients have the right of access to their protected health information, actual access remains limited. A new study, published in JAMA Network Open, has found that the processing of requesting medical records remains burdensome despite policy efforts.
Although patients have the right of access to their protected health information, actual access remains limited. A new study, published in JAMA Network Open, has found that the processing of requesting medical records remains burdensome despite policy efforts.

The authors noted that while federal regulations require a medical record request be fulfilled within 30 days of receiving the request, that hospitals impose costs and add procedural obstacles that prevent patients from accessing their records.

“With recent efforts by the federal government to launch the MyHealthEData initiative, which encourages patients to take control of their health data, it is important to assess and quantify the challenges that patients currently face in medical records request processes in the United States,” the authors explained.
They evaluated the state of medical records request processes through a cross-sectional study of request processes between August 1, 2017 and December 7, 2017, among 83 top-ranked hospitals in the United States. They also called the hospitals for data of what information can be requested, what formats the information can be released in, the costs of accessing records, and processing times. Three hospitals had been unreachable by telephone were not included in the analysis.

Only half (53%) of the hospitals gave patients a form with the option to acquire their entire medical record, which indicated a lack of transparency, the authors claimed.. The majority (88%) gave patients the option of accessing laboratory results and only 11% provided the option of releasing physician orders.

Hospitals provided more information on telephone calls about the formats they could release information compared with the medical records release authorization forms. On the phone, more hospitals stated they could release information by in-person pick up, fax, email, and CD. However, more hospitals disclosed on the forms that information could be released onto online patient portals. Mail was provided as an option by all hospitals in both phone calls and on the forms.

Only 35% of the hospitals disclosed the exact costs of accessing information on the authorization forms or on the page where the form could be downloaded. However, 22% stated that there was a cost but did not specify, and 43% didn’t specify any fees at all. Only 1 hospital released records for free.

Most hospitals released records in electronic format faster than paper format with the time of release for paper formats ranging from the same day to 60 days. In addition, the analysis found 7 hospitals had time ranges that went beyond their state’s requirement.

The findings showed that since each institution creates unique processes, there was variability in what records could be requested and how records could be received. The researchers noted that the “lack of a uniform procedure” to request medical records in the United States “highlights a systemic problem in complying with the right of access under HIPAA.”

The authors noted that since the study only included highly ranked hospitals, the results may not be representative of the process of requesting medical records at all hospitals in the United States.

“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,” the authors concluded.

Reference

Lye CT, Forman HP, Gao R, et al. Assessment of US hospital compliance with regulations for patients’ requests for medical records. JAMA Network Open. 2018;1(6):e183014. doi:10.1001/jamanetworkopen.2018.3014.

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