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Keith Loria is a contributing writer to Medical Economics.
Practices must adhere to all record requests-or face legal consequences
Last year, St. Petersburg, Fla.-based Bayfront Health paid an $85,000 fine to the U.S. Department of Health and Human Services Office of Civil Rights for failing to provide a pregnant woman with a complete copy of her medical record-which included the fetal heart monitor records of her unborn child-within the 30 days required by HIPAA.
This is significant because it shined a light on an issue that many physicians aren’t aware: with limited exceptions, HIPAA gives patients the right to get copies of all of their medical records and allows them to see all original medical records, usually at a medical provider’s office.
Shuhan He, MD, an emergency medicine physician at Massachusetts General Hospital, says one of the most common misconceptions is that patients somehow are limited in obtaining their own medical records because of HIPAA.
“Many smaller practices actually use it as a way to prevent patients from accessing their own records for fear of mishandling data in some capacity,” he says. “What I always emphasize is that the legislation itself was called the Health Insurance Portability and Accountability Act. The rule actually encourages patients to access their own information and move it between practices, even if providers and healthcare entities are required to protect that information at a higher burden.”
Thus, patients are treated as the ultimate decision-makers regarding their data. That’s important, he notes, because data is often used for ad targeting, resold to other companies for email spam, and basically used as a treasure trove for companies to monetize.
As an example, Shuhan He says, if he were to see a patient with heart pain at 2 a.m. in the emergency department, and it was someone who was on vacation or whose doctor wasn’t immediately available, he would have to make assumptions about the person’s medical history based on just the acuity, because of his inability to obtain records quickly.
“If the patient had clearly documented medications and imaging history, and perhaps previous diagnoses, I’d love this information,” He says. “It helps me put the patient’s symptoms in context. But I don’t have time to request medical records in this situation, so I will be ordering much more diagnostic imaging and lab results to ensure I don’t miss any critical diagnosis.”
Providing the Records
Anwar A. Jebran, MD, a third-year internal medicine resident at Weiss Memorial Hospital in Chicago, says providing access to records is necessary as it enables patients to make informed decisions, and every patient has a right to obtain their records in a timely manner.
“That’s why practices need to have a process in place,” he says. “There should be … an efficient and simple process to provide records in a timely fashion, and quality improvement projects should be performed consistently to improve this process.”
Alam Hallan RPh, CDE, director of pharmacy at Guelph General Hospital in Ontario, says access to records empowers patients and gets them more engaged in their health, improving patient satisfaction and reducing cost.
He suggests practices use systems that are compatible with interoperability standards such as HL7 FHIR, an interface for exchanging electronic health records, which would eliminate much of the manual workload associated with accessing records.
“For practices without that, having a system to handle these requests with posted timelines works well,” he says. “Corroborating information with the patient before adding it to their health records is also a good practice of verbally sharing the patient’s health records and then giving them the option of either giving them a copy or letting them manage their own documents.”
Dusty Hall, owner of Nab Life Health, an internal medicine clinic in Niceville, Fla., says patients at his clinic can fulfill medical record requests either by the patient completing a medical information form or providers sending a request to the office, typically via fax.
MGH’s Shuhan He says all patients should own their records and understand how to document t and protect them as they would their critical legal documents.
“I encourage patients to take photos of their X-rays and take photos of printed versions of medical records at discharge,” He says. “If a patient requests it, I will print their medical record from the visit as well.”
The HIPAA Privacy Rule permits a covered entity to charge a reasonable, cost-based fee that covers certain limited labor, supply, and postage costs that may apply in providing an individual with a copy of medical records in the form and format requested or agreed to by the individual.
However, the laws for copying medical records vary from state to state in terms of fees. For instance, in Florida, searches for medical records are $1 per search per year, and $1 per printed page and $2 for microfilm.
“It gets more complicated when you cross state lines so our fail-proof policy is simply not to charge at all,” Hall says.
Healthcare systems often charge a fee for handling and time of administrators to prepare documents, which many doctors feel is totally reasonable because it does take time as a medical record can often be hundreds of pages long between physician notes, notes from nursing, pharmacy, radiology, lab values, EKG’s, and more.
Jebran says insurance should cover these fees as delaying or not accessing the records for financial reasons might harm the health and safety of the patient in the long run and might delay patient care.
The law is very clear. People have a right to their data. While it’s an important part of those in healthcare to make records easily accessible, this acknowledgement has taken time and new talent to come into the industry to see this viewpoint, Jebran says.