Are EHR goals being achieved? This question has become increasingly relevant especially with most health systems implementing the electronic health record. Even in the face of existing concerns with interoperability and hybrid medical records (paper-based and electronic ones), stakeholders in the industry believe that EHR systems have made processes such as medical records review easier overall. However, easy access to the records remains a problem.
A new report from the GAO (Government Accountability Office) has found that some patients still face challenges such as hefty fees or reluctant providers when attempting to obtain access to their own EHRs. Patient concerns include the following.
- Some patients incurred fees they thought were excessive to access their medical records. For instance, patients with chronic conditions are likely to have lengthy medical records and therefore copying charges could also be huge.
- Some patients said they were unaware they had the right to challenge providers who denied them access to their own medical information.
- Patients do not always know they can submit a formal complaint to HHS’ OCR (Office for Civil Rights) when denied access and could benefit from specific educational efforts that increase awareness regarding these issues.
The GAO says that the fees charged for medical record access could vary based on the type of request and the state where the request is made. Medical providers are authorized to charge a “reasonable, cost-based fee” when patients make a request for their EHR. Patients have the authority to allow third parties access to their medical data. The fees for third-party access to the EHR are not however, subject to the reasonable cost-based standard; instead, they are governed by state law. Fees for third-party requests are typically higher than the fees charged to patients. This amount can vary considerably across the various states.
- Some states charge fees per page for patient and third party record requests. The amount charged may vary.
- States may specify a maximum allowable fee if the provider uses an EHR system. Some others may not differentiate costs for electronic or paper records.
- Some states like Kentucky allow patients one free copy of their EHR, followed by a charge of up to $1 per page for additional copies.
Patients are not the only entities at the receiving end. Healthcare providers have their own woes. The GAO found that:
- The costs of responding to patient request for records due to the allocation of staff time and other resources are challenging to providers.
- Patient advocates, healthcare organization staff, and ROI vendors may not have the expertise required for responding to medical record requests in an HIPAA-compliant way.
- Fulfilling requests for medical records has become more challenging and complex for providers. This is because of the existence of hybrid records and the medical information being stored in multiple EHR systems.
So, are providers and other stakeholders satisfied with the move to the EHR? EHR implementation has speeded up the implementation of patient portals. This is perceived as an advantage because it has in turn reduced the number of patient requests for their medical records – patients can now directly access some health information via these portals. Though the medical details released on the portals are not complete, patients said they benefited from the information available online.
The OCR makes available educational materials to patients as well as healthcare providers regarding patient rights to their own medical records. Other activities of the OCR include:
- Investigating complaints about patient access to medical records
- Auditing a sample of providers to determine HIPAA compliance
- Reporting to Congress about the state of HIPAA compliance among providers
The government’s MyHealthEData initiative also focuses on improved EHR patient data access. This is designed to provide patients more control over their own EHR data by removing existing barriers to health data access and use. The CMS is also doing their part by requiring providers to update their systems with health data exchange capabilities. They have mandated that providers must enable the patient’s health data to accompany them even after they are discharged from the hospital.
Patient data needs to be made accessible to authorized entities because this is important from the point of view of proper care provision as well as from that of claims settlement and medical litigation. Unhindered availability of the medical documentation would facilitate medical peer review, and processes such as medical record analysis that is very important in personal injury litigation. Most importantly, improved EHR patient data access would ensure improved patient engagement and also enable shared decision-making between providers and patients.