New Rules Give Patients Access to Medical Records

New HIPAA rules require providers to provide copies of any medical record within 30 days without charge (except for copying costs). Requests cannot be refused except in extraordinary circumstances.

The U.S. Department of Health and Human Services (HHS) recently issued guidance that healthcare providers must provide individuals requesting access to their medical information with copies of their protected health information (PHI) within 30 days of receiving a request, free of charge. The guidance titled Individuals’ Right under HIPAA to Access their Health Information 45 CFR § 164.524, encourages providers to have procedures in place to make all medical records available in a timely manner.

“Putting individuals ‘in the driver’s seat’ with respect to their health also is a key component of health reform and the movement to a more patient-centered health-care system,” the agency said in a press release. “For example, individuals with access to their health information are better able to monitor chronic conditions, adhere to treatment plans, find and fix errors in their health records, track progress in wellness or disease management programs, and directly contribute their information to research.”[1]

Under the New Guidelines:[2]

  • Physicians and hospitals can no longer require patients to provide a reason for requesting the records
  • Physicians and hospitals cannot refuse access to records out of a general concern that patients may be upset by the information
  • When a patient requests their records be mailed to them, healthcare providers cannot require patients to pick up their records in person
  • Medical records cannot be withheld if a patient has not yet paid his or her medical bills
  • Physicians and hospitals may include a reasonable fee associated only with the labor for copying the requested PHI, whether in paper or electronic form
  • Physicians and hospitals may charge a fee to cover costs associated with labor to prepare an explanation or summary of the PHI
  • Providers cannot charge the patient for the cost of search and retrieval of data, unless, in advance, the individual both chooses to receive an explanation or summary and agrees to the fee.
  • Providers should post on their websites or otherwise make available to individuals an appropriate fee schedule for regular types of access requests.

In one published pilot project involving 105 primary care physicians (PCPs), it was found that patients who were able to see their doctor’s notes said they could better understand their illness and better remember their treatment plan and were also more likely to take their medications as prescribed. The pilot also showed significantly improved patient satisfaction and education, significantly improvements in patient safety, and all of the PCPs who participated said they would continue at the end of the experiment.

Health care providers may deny requests only if the disclosure of personal health information is “reasonably likely to endanger the life or physical safety” of a patient or another person. Under the new rules, certain information might be denied to a suicidal patient and physicians are able to withhold patient psychotherapy notes that are kept separate from the medical file.[3]

Ease of Access

The new guidance will not only make it easier for patients to request and receive personal health information but it will also paint a clearer picture for providers.[4]

“Today’s guidance will be a big help to health care providers who need a clear interpretation of the law as health records have become digital. HHS recognizes the essential role health information plays in enabling consumers to better manage their health and care, and this guidance will help eliminate many problems patients routinely encounter when they try to access and use their information,” Christine Bechtel, campaign coordinator for GetMyHealthData said in a statement. “Patients continue to tell us that cost is a significant and unexpected barrier to getting their digital health information. They also struggle to have their records sent to consumer health apps, researchers and family caregivers. HHS is showing great leadership in addressing these issues.”[5]

Implications

The shift to EHRs has in some ways made it easier for providers to share information. While it appears that a majority of patients prefer increased access, some have reported negative aspects, such as reading offensive language in patient notes, inconsistencies in content and technical problems with the EHRs.

Under the Health Insurance Portability and Accountability Act of 1996, patients are supposed to receive access to their personal health records within 30 days of requesting them. Despite this, says Deputy Director for Health Information Privacy of the Office for Civil Rights, Deven McGraw, the continuation of delays and fees has led to patient access to medical records ranking among the top five issues investigated by his office.[6]

For patients with chronic illnesses, the fees charged by doctors and hospitals for providing medical records can add up and make it increasingly difficult to pay for and manage care.

When patients have their medical records on hand, it becomes easier to participate in and make informed decisions about their care, provides opportunity to correct any errors that exist within their patient files, the information can be used to avoid repeating medical tests and procedures, and they may be better able to communicate with medical staff. Despite initial concerns from many physicians, it is also believed that patient access to records will lead to fewer malpractice claims because of the increase in trust and transparency.

“Based on recent studies and our own enforcement experience, far too often, individuals face obstacles to accessing their health information,” said Jocelyn Samuels, director of the Office for Civil Rights at HHS.[7] “Providing individuals with access to their health information is a necessary component of delivering and paying for health care. We will continue to monitor whether the fees that are being charged to individuals are creating barriers to this access, will take enforcement action where necessary, and will reassess as necessary the provisions in the Privacy Rule that permit these fees to be charged,” the agency wrote.

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[1] Landi, Heather, “HHS Says Copies of Patients’ Medical Records Should be Free of Charge,” Healthcare Informatics, February 26, 2016

[2] Kuhrt, Matt, “New Guidelines Remove Barriers between Patients and Their Medical Records,” FiercePracticeManagement, January 20, 2016

[3] Pear, Robert, “New Guidelines Nudge Doctors to Give Patients Access to Medical Records,” The New York Times, January 16, 2016

[4] Kuhrt, Matt, “New Guidelines Remove Barriers between Patients and Their Medical Records,” FiercePracticeManagement, January 20, 2016

[5] Landi, Heather, “HHS Says Copies of Patients’ Medical Records Should be Free of Charge,” Healthcare Informatics, February 26, 2016

[6] Kuhrt, Matt, “New Guidelines Remove Barriers between Patients and Their Medical Records,” FiercePracticeManagement, January 20, 2016

[7] Landi, Heather, “HHS Says Copies of Patients’ Medical Records Should be Free of Charge,” Healthcare Informatics, February 26, 2016