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Survey: Many Providers Charge Patients for Medical Record Access

January 12, 2015
by Rajiv Leventhal
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More than half of providers charge their patients for electronic copies of their medical records, and nearly two-thirds said they charge patients for paper copies of their medical records, according to new research published by the American Health Information Management Association (AHIMA).

Charges for electronic copies varied from a flat fee for a device to per-page fees or some combination of the two, and charges for paper copies were generally by page, with 65 percent of respondents reporting that they charged less than $1.00 per page. Nearly one in four respondents (23.6 percent) commented that they follow their state’s rates for copies. Following the state rates would suggest that the fees are not uniquely based on the cost to the facility. This finding would appear to be inconsistent with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) requirements that patients may only be charged a “reasonable cost-based fee” for copies of their medical records, the researchers found.

To this end, currently, HIPAA allows providers to charge patients a “reasonable” cost-based fee for providing paper or electronic copies of medical records; most states also have statutes setting the maximum fees that may be charged for copies of medical records. Neither HIPAA nor the state statutes require that patients be charged for access to and copies of their medical records, as cost could present a barrier to patients, discouraging them from accessing information they need to better manage their health.

HIPAA defines the maximum fees that patients can be charged for their medical records, and the criteria for meaningful use further distinguish the patient from other third parties who may seek access to patient health information. Under HITECH, patients have the right to request their health information in electronic form. The act requires that any fee imposed to provide the electronic copy cannot exceed the labor and supply costs of responding to the request.

The survey also found that 87.5 percent of respondents indicated that they have an electronic health record (EHR) system. Of the respondents with an EHR system, 38.0 percent reported that they have a patient portal. However, portal utilization by patients was reported to be very low, with nearly 50 percent of the healthcare organizations with a patient portal reporting that less than 5 percent of their patients use the portal. Stage 2 of the meaningful use program requires eligible professionals to provide patients the ability to view online, download and transmit their health information, and they must get more than 5 percent of their patients to actually use online portals.

The survey was conducted under a partnership between Texas State University and the AHIMA Foundation, with respondents including 313 executives across several different healthcare settings. “The healthcare industry is at a crossroad of converging technology and regulations influencing patients’ access to their personal health information. This research revealed wide variation in contemporary practices affecting patient access,” the researchers concluded. “HIM professionals are uniquely positioned to play a practical and strategic role in ensuring that patients are able to access, utilize, and share their health information. The time is opportune for HIM professionals to evaluate their policies and procedures to ensure that patient access is provided in secure and patient-friendly ways.”

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