- High record copying fees and other out-of-pocket costs may be a deterrent for patient health data access, with some providers charging fees for chronically ill patients or third parties that are prohibitive, according to a recent report from the Government Accountability Office (GAO).
The GAO report did not identify how many patients decline access to their own medical records due to cost. However, the report did note variation in cost for health data access from state to state, higher costs for third parties, and other barriers patients and providers face in patient data access.
Under current HIPAA law, healthcare organizations must provide patients with access to the patient’s own medical records, but they may charge a “reasonable,” cost-based fee. Fees should usually cover labor and material costs.
This provision does not extend to third parties, the GAO report stated. When an attorney, for example, is authorized to request patient medical records, she may face exorbitant copying fees that are larger than fees patients face.
These fees, among other challenges, make it difficult for patients to obtain access to their medical records. In interviews with various healthcare officials, GAO learned that patients with a chronic illness often face cost-prohibitive copying fees because of the length of their medical records.
Additionally, limited information and education about patient rights to health data serve as obstacles. Some patients are still denied access to their medical records, as are many third-parties attempting to obtain medical records on a patient’s behalf.
Many providers are unaware of patient rights to their medical records, the report noted.
To overcome those issues, patient advocates and provider stakeholders agree providers could benefit from better education about patient data access rights and protocol.
Currently, HHS and its Office for Civil Rights (OCR) have pamphlets educating both patients and providers about patient rights to their medical records. The Office of the National Coordinator for Health IT (ONC) has also issued a guidebook breaking down the steps a patient can take to obtain copies of her own medical records.
Providers also face their own challenges when issuing patients copies of their medical records.
“Multiple stakeholders we interviewed told us that responding to patient requests for medical records can be challenging because it requires the allocation of staff and other resources and as a result, responding to such requests can be costly,” the GAO report explained.
“Furthermore, a provider representative, three representatives from ROI vendors, and a patient advocate confirmed that providers and their staff may lack the expertise needed for responding to requests for medical records in a manner that complies with HIPAA and applicable state laws.”
Extracting medical records from an EHR is not a simple task, and can result in reports that are hundreds of pages long. This is a difficult task for providers and can be costly due to labor and materials.
Additionally, the relatively recent transition to EHR technology serves as a provider barrier. The transition to EHRs has caused some records to merge, which requires providers to parse through the data to ensure patients receive their correct information. This will avoid health data privacy issues.
Although transitions to EHRs have caused some hiccups for providers offering patient data access, technology has also eased the process.
“While health information technology has created some challenges for providers, numerous stakeholders we interviewed told us that the technologies have made accessing medical records and other information easier and less costly for patients,” the report pointed out.
The use of patient portals has reduced the number of patients requesting copies of their medical records because patients already have this access using the technology. However, there are some patients who still prefer to obtain paper copies of their medical records.
The GAO report also reviewed various state regulations for patient data copying fees. Specifically, the report analyzed protocol for four states.
Three of those states have per-page fees for third party patient data access. One of the three states has a different copying fee rate for third parties compared to fees for patient requests. The other two do not have a different fee for patient and third-party requests.
In the fourth state, patients may receive a free copy of their medical records. After that, patients may incur up to $1 per page for additional medical records copies. This cost can become prohibitive if a patient has an extensive health history, such is the case for patients with one or more chronic illnesses.
This GAO report did not include specific recommendations, but it did offer insights into how patients and providers both approach patient health data access. Additionally, the report noted the importance of better education about patient rights for health data access.