Patients still face many challenges in accessing their health information, a federal watchdog has found.
According to a new audit (PDF) by the Government Accountability Office, many patients struggle to get their health records due to what they say are high fees, which can vary widely by state and method of delivery.
For example, Rhode Island has a $100 pricing cap for electronically stored medical records, while Kentucky will provide a record without charge.
Some states also charge per page, which can be costly for patients who have had a long medical history or complicated services. The audit described two patients who had been charged more than $500 for a single medical record request. Additionally, the fees for third-party requests are typically higher than those charged to patients, the watchdog found.
The GAO noted that the high costs can cause some patients to cancel their requests and that many don't know that they have a right to challenge providers who deny them their records. Patients often seek their records when shopping for new insurance plans, dispute coverage or apply for disability.
Fulfilling requests can also be burdensome for providers as well, as many have multiple or legacy systems, or a mix of paper and electronic records.
"Providers’ challenges include the costs of responding to patient requests for records due to the allocation of staff time and other resources,” the GAO said.
HIPAA guidance released by the Department of Health and Human Services (HHS) in 2016 places limits on how much providers can charge for records requests while accounting for labor costs. But a recent lawsuit filed by Ciox Health, a medical records fulfillment company, has sued the agency arguing those limits are "irrational" and "arbitrary."
HHS has launched several new efforts to make medical records more interoperable in order to give patients access to their data.
In an April proposed rule, the Centers for Medicare & Medicaid Services (CMS) said it wants providers to adopt 2015 Edition Certified EHRs beginning in January 2019. The agency also requested feedback on changing Medicare Conditions of Participation to require hospitals to provide electronic access to patient records.
Transferring over to electronic records isn't always a simple transition, however.
According to the GAO audit, some records are improperly merged when providers scan existing paper records into EHRs.