Before performing a release of information to fulfill a records request, it’s important to understand patient rights to medical records. Accommodating medical record requests is notoriously complicated and time-consuming, especially for old records.
However, it’s important to remember that patients have the federal right to access their medical records. Let’s dive into these legislations in detail and explore how they empower healthcare providers and patients alike.
Can a Healthcare Provider Deny Access to a Patient’s Medical Records?
In most cases, healthcare providers should not hinder patients from accessing their medical records because HIPAA empowers patients to access their PHI. Custodians must give patients copies of medical records when they request it orally or in writing.
This means that as long as you are the patient, guardian of a minor patient, or authorized representative, you have the right to access medical records.
There are several reasons why this is critical:
- Patient Empowerment: Access to medical records empowers patients to actively participate in their healthcare decisions. Patients can make well-informed choices about their care by gaining insights into their health conditions, evaluating treatment options, and understanding risks and benefits.
- Enhanced Patient-Provider Communication: Medical record access improves patient and provider communication. Patients can review records, prepare questions, and better understand their physician’s instructions.
- Accuracy of Records: By giving patients access to their medical records, providers enable them to verify accuracy. Patients can offer corrections about any errors or omissions, such as wrong medication dosages or unlisted allergies.
- Continuity of Care: Access to medical records improves care continuity for patients seeing multiple specialists or transitioning to a new doctor. It ensures coordinated and efficient care by enabling all healthcare providers to access the same information.
- Transparency and Trust: Providing patients access to their medical records fosters transparency. It also enhances trust between healthcare providers and patients.
- Emergency Situations: In the event of an emergency, having immediate access to health records can be a lifesaving tool.
According to the Office of the Civil Rights (OCR) Breach Portal, OIG has fined over 800 healthcare providers for violating patient rights to medical records from July 2021 through January 2024.
The Three Major Legislations Governing Patient Rights to Medical Records
Patients’ rights to access their medical records haven’t always been as strong as they are today. Before 1996, there was little preventing healthcare providers from sharing medical records with employers, relatives, or anybody else with a convincing reason for needing them.
In this section, we’ll dive into how HIPAA, the Cures Act, and the Right of Access Initiative provide and enforce patient rights to medical records.
How Does HIPAA (Health Insurance Portability and Accountability Act) Impact Patient Rights to Medical Records?
The United States enacted HIPAA in 1996 to protect individuals’ health information while allowing them access to their records. It provides patients with greater control over their health records and restricts access to unauthorized persons.
Under HIPAA, patients have the right to:
- Inspect and Obtain a Copy: Patients have the right to inspect and obtain a copy of their protected health information (PHI) contained in a designated record set. This includes medical and billing records.
- Request Corrections: If patients believe that information in their record is incorrect or important information is missing, they have the right to request that the healthcare provider correct the records. The provider must respond within 30 days of the request. They can extend this for another 30 days if they provide the requestor with a proper reason.
- Receive Confidential Communications: HIPAA allows patients to specify how and where their healthcare provider should share their PHI. For example, a patient can ask the provider to contact them at work rather than at home.
- Receive a Notice of Privacy Practices: Covered entities must give individuals a Privacy Practices Notice. This notice must explain patients’ rights to their medical records and outline how the provider may share their records.
- File Complaints: Patients have the right to voice complaints to healthcare providers, health insurers, and the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) if their rights are being denied or their health information is not adequately safeguarded.
- Request an Accounting of Disclosures: Patients have the right to receive an accounting of disclosures. Document custodian must list all disclosures of PHI made by the covered entity or its business associates.
The Right of Access Initiative: Expanding Patient Access
The Right of Access Initiative further expands the rights to access medical records by actively enforcing HIPAA requirements. This initiative emphasizes enforcing the existing HIPAA rights that allow patients to access their health information promptly, in their preferred format, and at a reasonable cost.
It’s an effort to remove any barriers hindering patients from gaining full control over their health information. It also encourages provider compliance with timely and reasonable access requirements.
This initiative is crucial for more effective communication between patients and healthcare providers. It ultimately enhances the patient’s understanding of their health conditions and treatment options.
The Right of Access Initiative enforces the following patient rights for medical records:
- Access to Most Health Information: This initiative demands that healthcare providers give patients full access to their health information, not just a summary. This includes lab results, treatment plans, and other essential health data but does not include any PHI that HIPAA prohibits custodians from sharing.
- Timely Access: Healthcare providers are obligated to provide access to health records within 30 days of the request. They can extend this deadline by an additional 30 days if they give a written notice with a valid reason to the requestor.
- Choice of Format: Patients have the right to receive their health records in the format of their choice.
- Affordable Cost: Providers can charge a reasonable, cost-based fee to cover labor, supplies, and postage but not for search time or retrieval.
- Third-Party Access: The initiative also gives patients the right to direct their health information to a third party of their choice.
The 21st Century Cures Act and Its Role in Patient Rights
The 21st Century Cures Act is a significant healthcare legislation enacted in December 2016. It aims to strengthen patient rights by doing the following:
- mandating greater access to electronic health information
- prohibiting information blocking
- speed up medical product development and encourage innovative, efficient solutions to major health challenges.
In essence, the Cures Act seeks to expedite the process of bringing new treatments and therapies from the laboratory to patients.
Provisions Under 21st Cures Act Include:
- Access to Electronic Health Information: Under the Cures Act, patients are given the right to access all of their EHI. This includes clinical notes, lab test results, and imaging studies, among other data.
- Information Blocking Prohibition: The Act prohibits healthcare providers, health IT developers, health information exchanges, and health information networks from engaging in practices that prevent or materially discourage access, exchange, or use of EHI.
- Standardized APIs: The Cures Act requires standardized APIs, facilitating EHI integration into mobile apps and software platforms to improve patient access.
- Patient Consent to Share Substance Use Disorder Records: The Act changes regulations on the confidentiality of substance use disorder patient records. Patients can choose whether to consent to disclose their records to chosen entities or not.
- Interoperability: The Act puts a strong emphasis on interoperability. It sets guidelines for the shared use of digital systems and processes among different healthcare providers, thus making it easier for patients to access their health records across different systems.
- Patient Access to Clinical Trials: The Cures Act also aims to increase the transparency of clinical trials, granting patients access to information about ongoing research.
Deadlines and Compliance: What Healthcare Providers Need to Know
Both the Right of Access Initiative and the Cures Act have implemented deadlines for healthcare providers to comply with patient rights. These deadlines ensure timely access to health information, promote transparency, and protect patient privacy.
- HIPAA necessitates that covered entities must generally grant individuals access to their health information when requested. It also stipulates that an Authorization for disclosure of protected health information may have a specified expiration date.
- In certain scenarios, where the timing of the individual’s request and the nature of the test do not allow for a 30-day response period, HIPAA permits an extension.
- All HIPAA-associated documentation must be maintained for at least six years from the last date a policy or document is effective.
Failure to meet these deadlines can result in significant penalties, including fines and legal action. Healthcare providers must stay informed about these deadlines and comply with patient rights to avoid repercussions.
OCR is responsible for enforcing these rules and has fined several practices that are found to grossly violate HIPAA provisions in any way. The penalty can range from $100 per violation to $1.5 million as the highest.
Here are a few notable cases:
- The fine for a data breach at New York-Presbyterian Hospital / Columbia University Medical Center amounted to $4.8 million.
- In 2020, Premera Blue Cross, a health plan provider located in the Pacific Northwest, consented to a $6.85 million penalty to OCR for a security breach that impacted more than 10.4 million individuals.
- In 2019, the University of Rochester Medical Center (URMC) paid $3 million to OCR. This payment was made to settle potential violations of HIPAA’s Privacy and Security Rules. URMC also implemented a comprehensive corrective action plan as part of the settlement.
Pricing Considerations for Patient Access to Medical Records
With the implementation of these initiatives, patients have more control over their health information. However, it is essential to also note that healthcare providers can still charge reasonable fees for providing access to medical records. These fees may vary depending on several factors.
Here are some crucial pricing considerations for patient access to medical records:
- Labor Costs: This includes costs associated with locating and retrieving records, copying medical information, and preparing a summary or explanation.
- Supply Costs: These may include costs of paper, electronic media (e.g., CD), or postage involved in fulfilling the request.
- Labor Costs: Healthcare providers may charge a reasonable fee for the time spent fulfilling a patient’s request, including labor costs associated with copying or scanning records.
- Format of Records: The fees charged may also vary based on the format of records requested. For example, electronic copies may be cheaper than printed versions.
Fees example by state:
- California: Healthcare providers can charge 25 cents per page of paper copies plus a reasonable clerical cost.
- Texas: 20 $25 for the first 20 pages and additional cost for more pages.
- Florida: Healthcare providers can charge up to $1 per page for the first 25 pages and $0.25 for each additional page.
- New York: Providers can charge fees not exceeding $0.75 per page.
- Illinois: Can charge $1.02 per page for the first 25 pages, $0.68 from pages 26 through 50, and $0.34 for each page over 50. They also charge a handling fee of $27.33.
For a full list of pricing limits, you can refer to our list of medical copy fees by state.
Best Practices to Comply with Patient Rights to Medical Records
Violating a patient’s right to access their medical records should be avoided at all costs. Enacting thoughtful strategies and best practices is essential to ensure compliance with the major regulations.
Here are some best practices that healthcare providers can follow:
- Risk Assessments: Regularly conduct thorough assessments to identify potential vulnerabilities in your privacy and security controls.
- Employee Training: Ensure all staff members are trained on HIPAA regulations, the Cures Act, and patient rights of access.
- Implement Safeguards: Install physical, technical, and administrative safeguards to protect patient data. These include secure servers, encrypted emails, and restricted access to patient records.
- Incident Response Plan: Have a clear response plan for potential patient data breaches.
- Promote Interoperability: Use health IT solutions that meet interoperability standards and avoid “information blocking”.
- Patient Access: Ensure patients have easy access to their electronic health information at no cost, in line with both the 21st Century Cures Act and patient rights of access under HIPAA.
- Data Sharing: Be prepared to securely share health data with other systems and applications with patient consent.
- Timely Access: Provide patients with timely access to their health records, generally within 30 days of their request.
- Reasonable Fees: If you charge fees for copies of health records, they must be reasonable and based on actual costs.
- Clear Process: Establish a clear and easy-to-follow process for patients to request their health records.
ChartRequest — Your Compliance Partner in Patient Rights to Medical Records
Protecting patient rights to medical records can be daunting and fraught with countless convoluted regulations. That’s where ChartRequest steps in as your compliance partner. We offer an unrivaled ROI platform for fast, secure, and compliant release of medical records.
The right to request medical records is universal, but stringent laws governing the release of information can bombard your staff, escalate overhead costs, and introduce severe financial penalties for unintentional HIPAA breaches.
Our mission at ChartRequest is to alleviate the pressures of compliant electronic health record release. This also helps healthcare professionals enhance patient outcomes with rapid record turnaround and simplified care coordination.
Discover how other healthcare providers have benefited from ChartRequest. Our case studies offer a glimpse into the transformative impact ChartRequest can have on your records management.
Ready to revolutionize your medical records process? Click here to request a live demo of ChartRequest. Experience firsthand how we can transform your records management, facilitating a more seamless, efficient, and compliant operation.