What Laws Impact Patient Rights to Medical Records?

Patient rights to medical records impact how healthcare organizations handle the release of information (ROI). Though record exchange can be tedious, you must still accommodate patient privacy and access above all else.

HIPAA outlines the rights patients have to their medical records. Let’s explore these rights and how they influence your ROI process.

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Can a Healthcare Provider Deny Access to a Patient’s Medical Records?

Patients have the right to access their protected health information when they please. Few exceptions exist, so healthcare providers should not attempt to delay the process without a legal cause. 

There are several reasons why accommodating patient requests is important:

Patient Empowerment

Access to medical records empowers patients to participate in healthcare decision-making. Patients can make informed choices about their treatment by gaining insights into their health conditions.

Enhanced Patient-Provider Communication

Medical record access improves patient and provider trust. Patients can review their records, prepare questions, and better understand their physician’s instructions. Medical record transparency is key to avoiding HIPAA violations and safeguarding your practice during OCR investigations.

Overall, improved patient communication and trust can boost your hospital’s reputation and contribute to business growth.

Accuracy of Records

Your patients can help verify the accuracy of their medical charts. They can correct errors or omissions, such as wrong medication dosages or unlisted allergies. Record accuracy also helps specialists outside of your facility continue necessary care without delay.

3 Rules 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.

Let’s look at how HIPAA, the Cures Act, and the Right of Access Initiative provide and enforce patient rights to medical records in the present.

HIPAA Standards

The United States enacted HIPAA in 1996 to protect individuals’ health information while allowing them access to their records. It gives patients greater control over their health records and restricts access to unauthorized persons.

Under HIPAA, patients have the right to:

• Inspect and obtain copies of their protected health information.
• Request corrections to their health record.
• Receive confidential communications from their healthcare provider (or other HIPAA-covered entities).
• Receive a Notice of Privacy Practices
• File complaints to the OCR (typically involving information blocking).
• Request an accounting of health information disclosures from their healthcare provider.

The Right of Access Initiative: Expanding Patient Access

The Right of Access Initiative further expands the rights to view medical records by enforcing HIPAA requirements. This initiative supports existing HIPAA rights that allow patients to access their health information promptly, in their preferred format, and at a reasonable cost.

The initiative is an effort to remove any barriers stopping patients from gaining full control over their health information. It also encourages provider compliance with reasonable access requirements.

Consider a few ways the Right of Access Initiative enforces patient rights:

• Access to Most Health Information: This principle demands that healthcare providers give patients full access to their health information, not just a summary. Complete records include lab results, treatment plans, and other essential health data. This excludes any info that HIPAA prohibits custodians from sharing.

• Timely Access: Healthcare providers must provide access to health records within 30 days of a request. They can extend this deadline by 30 days if they provide a written notice with a valid reason.

• Choice of Format: Patients have the right to receive their health records in the format of their choice. While most patients now prefer digital copies, others may request physical documents.

• 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: Patients have 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 law enacted in December 2016. It aims to strengthen patient rights by:

• mandating greater access to electronic health information,
• prohibiting information blocking,
• Accelerate healthIT development and encourage innovative solutions to industry challenges.

Elements of the Cures Act include:

Access to Electronic Health Information (EHI)

Under the Cures Act, patients have the right to access all of their EHI. This right includes clinical notes, lab test results, and imaging studies, among other data.

Information Blocking Prohibition 

The Cures Act prohibits healthcare providers, health IT developers, health information exchanges, and health information networks from engaging in practices that prevent or discourage access 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 Cures Act changes regulations on the confidentiality of substance disorder patient records. Patients can choose whether or not to disclose their records to chosen entities.

Interoperability

The Cures Act puts a strong emphasis on interoperability. It sets guidelines for the shared use of digital systems and processes among different healthcare providers. In other words, making it easier for patients to access their health records across different systems.

Patient Access to Clinical Trials

The Cures Act 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

The Right of Access Initiative and the Cures Act implemented deadlines for healthcare providers to comply with patient rights. These deadlines ensure timely access to health information, promote transparency and protect patient privacy.

1. HIPAA stipulates that an authorization for disclosure of protected health information may have a specified expiration date.

2. 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.

3. Custodians and providers must maintain all HIPAA-associated documentation 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.

Penalties for Violating the Right to Access

According to the OCR Breach Portal, over 800 healthcare providers violated patient rights to medical records from July 2021 through January 2024. OCR is responsible for enforcing Right to Access rules and has fined several practices that violate HIPAA provisions in any way. The penalty can range from $100 per violation to $1.5 million, which is the highest.

Here are a few notable cases:

1. The fine for a data breach at New York-Presbyterian Hospital / Columbia University Medical Center amounted to $4.8 million.

2. 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.

3. In 2019, the University of Rochester Medical Center (URMC) paid OCR $3 million. 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 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 pricing considerations for patient access to medical records:

• Labor Costs: Include locating and retrieving records, copying medical information, and preparing a summary or explanation.

• Supply Costs: Include costs of paper, electronic media (e.g., CD), or postage involved in fulfilling the request.

• Format of Records: The fees charged may reflect the requested format. For example, electronic copies may be cheaper than printed versions.

Fees for medical records vary from state to state. Keeping up with local registration is wise to avoid under or overcharging your patients.

Best Practices To Comply With Patient Rights to Medical Records

Violating a patient’s right to access their medical records is avoidable. Enacting thoughtful strategies and best practices will ensure compliance with the aforementioned regulations.

Here are some best practices that your organization can follow:

1. Risk Assessments: Regularly conduct thorough assessments to identify potential vulnerabilities in your privacy and security controls.

2. Employee Training: Ensure all staff members complete HIPAA training and understand the Cures Act and patient rights of access.

3. Implement Safeguards: Install physical, technical, and administrative safeguards to protect patient data. These methods include secure servers, encrypted emails, and restricted access to patient records.

4. Incident Response Plan: Have a clear response plan for potential patient data breaches.

5. Promote Interoperability: Use health IT solutions that meet interoperability standards and avoid “information blocking.”

6. Patient Access: Ensure patients have easy access to their electronic health information at no cost.

7. Data Sharing: Be prepared to share health data with other systems and applications with patient consent.

8. Timely Access: Provide patients with timely access to their health records, generally within 30 days of their request.

9. Reasonable Fees: If you charge fees for copies of health records, they must be reasonable and based on actual costs.

10. Clear Process: Establish a clear and easy-to-follow process for patients to request their health records.

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.

Our mission is to alleviate the pressures of compliant electronic health record releases. This responsibility also helps healthcare professionals enhance patient outcomes with rapid record turnaround and simplified care coordination.

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