- Patients believe providers are overcharging them for access to their medical records, according to a new report by the U.S. Government Accountability Office.
- As a result, some patients canceled requests for their records, unaware that they could challenge providers who deny them access.
- Responding to medical records requests also creates difficulties for providers, such as requiring staff time and other resources that can be costly.
As the movement toward value-based reimbursement gains steam, pressure is mounting for patients to get more involved in their healthcare decisions. Access to medical records can help them root out unnecessary or duplicate procedures and promote care coordination among their providers.
Apple is aiming to make a mark in the area. Earlier this year, the company announced it will allow iPhone users to view their medical records from participating providers on the device's Health Records section. Already nearly 40 health systems have signed on.
EHR interoperability remains a challenge, and the GAO, which is mandated by the 21st Century Cures Act to study patient access to medical records, found that fees can present another barrier.
The government watchdog talked to providers in four states and found a range of fee structures for accessing medical records. In Kentucky, patients are entitled to one free copy of their medical record and then face charges up to $1 per page for additional copies.
The other three states — Ohio, Rhode Island and Wisconsin — have differing per-page fees depending on the number of pages requested. They also have fees for media such as X-rays and MRI scans. Ohio has a separate per-page fee for requests from third parties, like lawyers.
HIPAA allows providers to charge patients a reasonable, cost-based fee when they seek copies of their medical records or request they be forwarded to another provider or organization. However, the reasonableness standard doesn't apply to requests from third parties, and GAO found that fees for such requests tend to be higher than those charged to patients regardless of location.
Patient advocates described fees in excess of $500 for a single record request, a patient being charged $148 for a PDF of her medical record and patients being charged an annual subscription fee to access their records, the report says. In one case, a hospital’s ROI vendor charged a patient a retrieval fee for a copy of her records, which HIPAA prohibits.
Per-page fees can be particularly hard on patients with serious or chronic conditions who have amassed thousands of pages of records, the report notes.
Beyond the costs associated with record requests, the investigation found that many patients aren't aware they can access their medical history. And providers are sometimes unsure how to handle requests from a patient’s family or caregiver.
The review also identified challenges for providers who respond to medical record requests. In addition to staff and resource costs, the process of retrieving records from EHRs can be overly complex. ROI vendors noted cases where records were incorrectly merged when paper versions were scanned into EHRs, necessitating page-by-page review of the record to ensure another patient’s information wasn't inadvertently released.
During the Medicare Advantage and Prescription Drug Plan Spring Conference in Washington, D.C., last week, CMS Administrator Seema Verma underscored the government’s commitment to the MyHealthEData initiative, which aims to eliminate barriers that prevent patients from accessing their medical records.
“Imagine if our health records weren't just used by our doctors in their workflow, but rather if EHRs allowed third-party applications to access and leverage that data in innovative ways for both the patient and doctor,” Verma said. “Imagine if patients could authorize access to their records to researchers from all over the country who could not only develop specific treatments for their needs, but the researchers could also use that information to develop cures that could save millions of lives.”