Study: Requesting medical records can be ‘complicated, burdensome’ for US patients

A study of more than 80 top-ranked United States hospitals found that medical record request processes can be “complicated and burdensome”––and even costly––for patients. Furthermore, not all hospitals were following federal regulations when it comes to giving patients access to their own records. 

In a study recently published in JAMA, Yale researchers analyzed medical records request processes at U.S. hospitals in an effort to gauge how hospitals are complying with federal and state regulations and if medical records are easily accessible for patients. While HIPAA gives patients the right to access their own protected health information, doing so can be a confusing process, based on the study results.

The results garnered attention from CMS Administrator Seema Verma, who has continually promoted the agency's MyHealthEData initiative to allow patients greater access to their medical records digitally. Via Twitter, she called the new study results "unacceptable" on Oct. 5.

The study was conducted between Aug. and Dec. 2017 at 83 top-ranked U.S. hospitals with independent medical records request processes and medical records departments reachable by phone. Researchers received information about the medical record release processes by analyzing authorization forms or speaking over the phone to records departments.

Of the 83 hospitals, 44 gave patients the option to acquire their entire medical record on authorization forms. Nine of the hospitals gave the option of releasing physician orders, while 73 had options to release laboratory results.

When getting information during telephone calls, all of the hospitals said they were able to release entire medical records to patients. Some noted that nursing notes would not be released unless they were specifically requested.

The results also revealed that more hospitals—via telephone, as opposed to request forms—said they were able to release information through several formats: in person, fax, email and CD. The study said “fewer hospitals stated in telephone calls than on the forms that they were able to release information onto online patient portals.”

“All hospitals stated in telephone calls and on the forms that they could release information via mail. Hospitals unable to provide records by fax stated that they could fax records only to physicians,” the study said. “Two hospitals reported not being able to release records electronically if the records were originally in a paper format.”

Costs for patients to obtain their medical records varied by format, according to the study. On authorization forms, 29 hospitals disclosed exact costs; 36 did not specify any fees; 18 said they would charge but didn’t specify a cost; and one stated on its forms it releases records free of charge.

“For a 200-page record, the cost of release as communicated in telephone calls ranged from $0.00 to $541.50,” the study said.

During phone calls, 82 hospitals disclosed costs for paper formats, and one was unable to disclose costs of release because it was determined by an outside party. To get records through an electronic format, some hospitals said they charge the federal recommendation of $6.50, some said they don’t charge, and others said they charge the same fees for electronic and paper formats.

Additionally, the authors found that 71 hospitals provided processing times for paper and electronic record releases while speaking over the phone—with most hospitals being able to release records in an electronic format in a shorter time frame.

“The time of release for records in paper formats ranged from same-day release to 60 days,” the study said. “Of the 81 hospitals that responded with times of release, seven had ranges extending beyond their state’s requirement before applying the single 30-day extension granted by HIPAA.”

Based on the results, the authors said the process for requesting medical records can be “complicated and burdensome” for patients. They also encouraged future legislation to address the barriers patients face during medical request processes.

“Requesting medical records remains a complicated and burdensome process for patients despite policy efforts and regulation to make medical records more readily available to patients,” the study concluded. “Our results revealed inconsistencies in information provided by medical records authorization forms and by medical records departments in select US hospitals, as well as potentially unaffordable costs and processing times that were not compliant with federal regulations.”