Many top-ranked hospitals don't comply with federal and state regulations for completing patient requests for medical information, according to a study published earlier this month in JAMA Network Open.
For the study, researchers examined the process for obtaining patient medical records over the phone and through request authorization forms from 83 hospitals that were ranked in the top 20 hospitals for adult specialties in U.S. News & World Report's Best Hospitals National Rankings.
Over a four-month period a medical student simulated a patient's experience by calling each hospital pretending to look for her grandmother's medical records. The medical student asked questions about the medical records process including how long it would take, how much it would cost, and what information was available.
Under HIPAA, patients have the right to access their medical records, and the federal government requires that medical record request be fulfilled within 30 days of receipt at a fair cost. According to Becker's Hospital Review, the federal government recommends charging $6.50 for copies of EHRs.
Accessing medical records is no easy feat, study finds
When the researcher called hospitals, all 83 said that they would release a patient's medical form in its entirety.
But only 44 of the hospitals' request authorization forms gave patients the option to request their medical record in its entirety.
Out of the 83 hospitals observed, 8% had ranges for the amount of time it would take to turn over records that went beyond their states' 30-day deadline to turn over patient records, the researchers found.
The researchers also found hospitals' charges for medical records often exceeded the federal government's recommended charge of $6.50. Charges for medical records ranged from $0.00 to $281.54, with one hospital charging $541.50 for a 200-page record. Only one hospital offered records completely free of charge.
All but one of the 83 hospitals disclosed the cost of paper records over the phone, but only 29 hospitals had the costs of the records on their website or request form. According to the study, 36 hospitals did not detail costs on their website or request forms.
Are hospitals to blame?
The researchers found that "even at the very best [hospitals]" patients face "inconvenience, delay and often high cost" when obtaining medical records.
According to G. Caleb Alexander, an internist and associate professor of medicine at the Johns Hopkins Bloomberg School of Public Health, the cost of the records are a barrier to access for many patients, which is most "concerning." He said, "Patients are entitled to know what is in their medical records." He added, "And unfettered access should be at a minimal cost."
But, while the study results are shocking to some, they "quantif[y] the everyday experience of many Americans trying to get access to personal health information from a hospital," said senior author Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at the Yale New Haven Hospital. Krumholz said it's up to hospitals and health systems to increase access to patients' medical records.
"[W]e don't need to lobby legislators in Washington for this," Krumholz said. "We need to get health systems in compliance with the law" (Spitzer, Becker's Hospital Review, 10/8; Carroll, Reuters, 10/9; Krumholz et al., JAMA Open Network, 10/5).
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