US hospitals make it difficult and exorbitantly expensive for Americans to access their own medical records – despite laws protecting their rights to their health information.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects not only the privacy of patient records, but their ability to request and receive documents about their health.
But the US government does not regulate the possible barriers between patients and their information.
A new Yale University study found that nearly 60 percent of top US hospitals charge more than the federal recommendation of $6.50 for electronic medical records.
That recommended fee is already 106,000 times more than it would cost to store a terabyte of information on Dropbox for a month.
Yet one hospital charged $541.50 per every 200-page record, which the study authors say is only an ‘average’ size record.
Pricey paper: A Yale University study found that the majority of top hospitals charge over the recommended (but unregulated) fee for patients to get their medical records
Medical records are a sensitive subject.
They contain deeply personal information about our bodies and overall health that is crucial to doctors’ ability to help us, but could be used to discriminate against us in the wrong hands.
HIPPA was passed in order to ensure that patients’ information could smoothly transition to new health care providers when they changed jobs and, often, had to change insurers and covered doctors as well.
It had the effect of pushing the notoriously slow-to-change medical industry toward digitizing records, a shift that was hastened by the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009.
So now most hospitals have most records in digital form, but it remains inordinantly difficult for patients to actually see those records.
For comparison, a terabyte of data – equivalent to about 75 million pages – costs $23 a month on the popular cloud storage service, Dropbox.
The new Yale study used 200-page medical records as its benchmark for assessing patient access to their information.
Federal recommendations suggest that hospitals charge a flat fee of $6.50 for each entire medical record.
That means that the US recommends that hospitals charge about 106,000 times more per page than DropBox does.
But that’s only a fraction of what some hospitals charge.
The Yale team found that the majority – 58 percent – of the 83 top-ranked US hospitals in the US charge more than that recommendation.
Though some do provide records free of charge, fees range all the way up to $541.50 at one hospital.
The $6.50 flat rate ‘is juts a recommendation, there’s not any regulation to enforce that,’ lead study author Dr Carolyn Lye told Daily Mail Online.
‘It’s just there if hospitals don’t want to go through the work of calculating the actual cost, but there’s nothing holding hospitals to this flat rate.’
She and her team found broad variation among the sample of hospitals they studied, but no patterns whatsoever in their fee scheduling.
‘For some, its a fee per page, or for however many pages plus processing. For others it’s a flat free, and there are many that provide records free of charge,’ Dr Lye said.
Charging per page may present a particular policy issue.
‘If a sicker patient were to request all their records from a particular hospital, in general they will likely be charged a higher fee … and that’s not fair,’ said Dr Lye.
She noted that for a full medical record, which could consist of decades worth of information recorded by doctors, nurses and practitioners in many specialties and states, 200 pages is quite short.
And for the time being, patients are helpless.
‘In terms of mitigating costs, at this point, if hospitals aren’t enforced [by regulations], there isn’t much that patients can do,’ said Dr Lye.
‘It’s more of a policy issue that needs to be enforced [to place] stricter limits on hospital fees.’
In some cases, states place caps on fees hospitals can collect on records.
New York, for instance, only allows doctors and their practices or hospitals to charge a maximum of 75 cents per page and the cost of postage for medical record copies – though that adds up fast, and physicians can tack on charges for certain elements of the record, like X-rays.
But even this regulation is part and parcel of an antiquated model – nearly a decade after the HITECH Act was passed, patient record procedures are still based on printed page counts.
‘As more hospitals start to use patient portals to make [health data] online, the cost might fall, but at this point there isn’t much to do to mitigate the costs,’ Dr Lye said.
‘Hospitals should be following the privacy rule under HIPAA that says they should be giving patients access to their records.
‘Plus, when they have access and can understand conditions that they have and their hospital’s course of treatment, patients are able to really play a part in the decisions in their health care, and that should really facilitate better healthcare provider-patient relationships and better healthcare overall.’