November 14th, 2014|
Electronic records are available with just a click of the mouse. So you think. Why is it so hard to get your own medical records? Although doctors and hospitals legally own their charts, federal law requires a response within 30 days to a patient’s request for information. In spite of that, it is unlikely you will get your complete medical chart in anything close to 30 days.
The New York Times published an article a few weeks ago detailing undisclosed or hidden charges in a medical bill. Peter Drier, the focus of the article, had back surgery by an “in network” doctor. When he discussed his upcoming surgery, no mention was made of any other surgeon being necessary. When he received his bill, there was a charge for an “out of network” doctor who “assisted” during surgery. The out of network surgeon’s bill was $117,000.00. Mr. Drier wanted to see a complete copy of his records to determine the validity and necessity of the charge. (The fact another surgeon was assisting requires further discussion.) The hospital required all records requests be sent by regular mail. He made numerous phone calls, signed consent forms and finally received an “estimate” for copying charges for his records. That bill was $100.00. Finally, Mr. Drier went to the hospital himself and sat in the records department until he was given a copy of his chart. 6 weeks later.
One would think in the digital age obtaining medical records would be relatively easy. But the hospitals and doctors make it costly, time consuming and difficult. Medical records are held hostage according to I. Glenn Cohen, a professor at Harvard Law School. The medical providers create a series of hurdles before they will release a patient’s records. Professor Cohen believes the reason is an economic one: “it keeps a patient from leaving the practice.” In defense, the medical providers claim HIPAA, the Health Insurance Portability and Accountability Act of 1996, requires privacy constraints be in place to protect patient information. But Dr. David Blumenthal, president of the Commonwealth Fund, claims HIPAA is used in all sorts of distorted ways. For instance, requiring a patient to return to the doctor’s office to learn that the results of a test were normal, thereby incurring a bill for the office visit when informing the patient over the telephone would have been easier for the patient. If patients have their medical records, they can move to other doctors whenever they want, deciding on less expensive testing sites and less expensive therapy services.
In 2009, legislation passed requiring medical records to be electronic with the goal being easier patient access and simpler sharing between medical providers. But sharing information goes against medical providers’ economic interests when trying to hold onto a patient, especially in hugely competitive markets where there are lots of health care choices. Additionally, the designers of medical records software incorporate “sharing difficulties” into their software thereby protecting the market they serve and adding a further layer of frustration for the patient. Some healthcare providers have developed systems to provide access by the patient to his or her records. The Cleveland Clinic’s My Chart system is a good start. It gives a patient access to his or her test results and notification of future appointments. But it does not give access to doctors’ notes, operative notes, therapy notes or other information necessary for a patient to make proper health care choices. It would be in the best interest of the patient for the patient to be able to review the office visit notes to make sure the patient’s information was recorded accurately, since most providers now sit at a terminal clicking away, leaving the patient to wonder if anyone is really listening. Having the chart available on line would allow the patient to review the doctor’s recommendations as well, since a patient may not hear or remember everything that was said during the visit.
For the most part, electronic medical records remain difficult to get in a timely manner when it should really be just a click away.