A recent study conducted by researchers at Yale University found significant deficiencies among 83 of the nation’s largest hospitals and health systems in how they provide medical record access to their patient population. One might expect that this deficiency was limited to limitations with the online medical record, patient portal or medical records portal access, but the study found that the problem runs much deeper. The Health Insurance Portability and Accountability Act (HIPAA), is a federal law that includes provisions to ensure that patients can access their medical records in a timely manner, at a reasonably low cost and in a format of their choosing.
When we think of the term “medical records” access for patients, in most cases, a complete Continuity of Care Document (CCD) will do. However, a CCD may or may not include lab results, so a typical “electronic” version of the “medical record” might include a CCD plus the patient’s lab results, imaging reports, discharge summaries, and other files as PDFs – which, by Bridge’s standards, is the standard “medical record” offering in their healthcare provider provided patient portal.
What were the results of the study?
Among the 83 hospitals, 44 (53%) provided patients the option on the medical record request forms to acquire their entire medical record. This doesn’t mean that a request for the complete record couldn’t be made with some effort, but the organization wasn’t making it easy for the patient to do so.
The study found similar results when it came to the medical record formats available. Hospitals were more likely to offer a greater number of options for how to release medical records when asked over the phone compared with on a form. The hospitals in the study offered the following options:
- Pick up in person (69 [83%] over the phone vs 40 [48%] via the medical record request form)
- Fax (20 [24%] vs 14 [17%])
- Email (39 [47%] vs 27 [33%])
- CD (55 [66%] vs 35 [42%])
* It is implied that a patient proficient with the internet would likely not be directed to complete a medical record request form if the “complete” medical records were available in some type of medical records portal (patient portal).
On the authorization forms, 29 hospitals (35%) disclosed exact costs either on the form or on the web page from which the form was downloaded. One hospital stated on its form that it releases records free of charge, 18 (22%) disclosed that they would charge patients but did not specify a cost, and 36 (43%) did not specify any fees. For a 200-page record, the cost of release ranged from $0.00 to $281.54, based on the 29 hospitals that disclosed costs.
In terms of processing times, 71 hospitals provided mean times of release for paper copies of records. A maximum time of release was provided by 10 hospitals, and 2 hospitals were unable to specify a mean or maximum time of release. Of the hospitals that provided mean times of release, 17 (21%) reported mean times of less than 7 days, 21 (25%) in 7 to 10 days, 26 (31%) in 11 to 20 days, 4 (5%) in 21 to 30 days, and 3 (4%) in more than 30 days.
Medical records online: Bridge’s analysis of the root cause
It goes without saying that a patient portal or mobile app which offers medical records online would solve the majority of these problems, but even with such systems, there are likely to be many instances where either a) the medical records are not a part of the standard medical record offering in the portal/app, in which case a request needs to be made; or b) medical records from the clinics associated with the health system, which often use different EHR systems, aren’t connected to the main system. This lack of integration across multiple internal EHR systems forces medical record staff to prepare medical record requests for patients manually.
Bridge uses its own proprietary interface engine to collect health summaries from multiple EHRs simultaneously. Even if existing interfaces to the EHRs don’t exist, Bridge provides patients with access to their medical records through both a client-branded web application and mobile app. Once in the application, most health summaries should be available as a result of the expanded interface. In the event that a request needs to be made for a medical record, the current methods imposed by healthcare organizations are cumbersome, requiring paper-based forms to be completed. With Bridge, when medical records are not available in the patient portal, an electronic request can be submitted in the portal, where it will then be sent to a tasking center for medical record staff to manage. Medical record attachments can be made directly in the task queue, simplifying the entire process.
Another aspect is the cost issue. Since patient portals are a free service, hospitals and health systems could fear a loss in revenue associated with patients’ medical record requests. HIPAA law does allow for a “reasonable” fee to charged to the patient for this access, so the incentive to offer such access is limited.
Our analysis of the situation is that few health organizations are truly motivated to make a change to the status quo. The entire market needs to shift toward becoming more consumer-driven and, as it stands, the patient will likely encounter much of the same if they go from hospital A to hospital B. Only the most innovative health organizations are putting a priority on the “patient experience”, and seeing how they can attract and retain patients through free and easily-accessible online medical record access.