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Will Lower EHR Copying Fees Improve Patient Engagement?

By Jennifer Bresnick

- While patient portals are becoming increasingly popular in healthcare organizations, especially as more providers seek to attest to Stage 2 meaningful use, but many patients, caregivers, or legal representatives still need to request copies of their complete medical records directly from office staff, who burn CDs or stand at copy machines to replicate patient data.  Whether paper or electronic, healthcare providers usually charge copying and access fees that can total in the hundreds of dollars, which may make full access difficult for patients with complex histories. 

Patient engagement and EHR data access

As New Jersey Assemblyman Bob Andrzejczak introduces a bill to slash access fees for paper and EHR documents in half, the place of medical record copying charges in a system that is supposed to be promoting interoperability and robust patient engagement rises to the surface once again.

The New Jersey legislation would cap medical record copying fees at approximately half their current rate, allowing providers to charge “a copying fee of no more than $0.50 per page plus an administrative fee of no more than $15, or $100, whichever is less,” for paper records and “the actual cost of reproducing the record or $50, whichever is less,” in the case of electronic health records. 

Patients who do not have the ability to pay these fees, including those benefiting from public assistance and all patients with incomes below 250 percent of the federal poverty level, would be able to receive free access to their records.  Non-profits or pro bono legal teams would also be allowed to appropriately access copies of a patient’s records for free.

“Capping [the fees] at $100 is definitely fair as far as covering the cost of whatever effort is being put in,” Andrzejczak said to  “What we’re trying to do is help out the elderly and help out people that are on a fixed income.”

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Most states have instituted rules about maximum copying fees for paper records, as files for patients with major health events or long-term chronic diseases often run into the hundreds of pages.  For patients seeking legal action, or those looking to ensure that new providers have access to previous records when patient portals are not detailed and complete enough, uncontrolled costs can be staggering. 

In 2014, South Carolina’s Speaker of the House Bobby Harrell (R-Charleston) introduced a law that mandated a $150 cap for EHR data  and a $200 limit on the copying of paper records after one state resident paid nearly $4000 in fees for a CD of her father’s data.

Four states currently allow providers to charge more than $100 for 75 pages of paper records, while more than a dozen keep those fees under $50, according to recent data from the Brookings Institution.  Many states and individual organizations have a relatively complicated formula for determining how much a provider can charge for records, and most keep the allowable costs EHR data close to those for paper copies – regardless of the fact that EHR data rarely requires a significant outlay in time or materials.

A January survey of health information management professionals found that many organizations think of state maximums as an acceptable baseline guideline for pricing structures, and might even be ignoring HIPAA and HITECH regulations that require providers to charge “a reasonable, cost-based fee” for record copies.

Why are patients still forced to make requests for records when patient engagement and patient portal requirements in the EHR Incentive Programs are supposed to put an end to the need for manual retrieval and copying of important patient data? 

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The problem is multi-faceted.  High fees may compel patients to seek other methods of data access, but patients aren’t always aware that they have the option to use a patient portal.  As a result, providers struggle to make their implementation and maintenance cost-effective.  In addition, patient portal technology is not always sophisticated enough to include the entire medical record, which keeps manual copying a necessity. 

The end result is that patients and providers both lose out on opportunities to make patient engagement and data access a positive, meaningful addition to the process of care.

Will lower fees help to mitigate the impact on patients while portal technology evolves to meet higher demands?  State legislators certainly think that putting caps on these charges is a step in the right direction, but providers must also commit to an attitude shift about data access if they are to make patient engagement and health information exchange a priority. 

Many providers do not always take advantage of opportunities to recruit patients for electronic data access, and may wish to integrate sign up queries into their intake or office visit workflows.  AHIMA suggests that providers who do have advanced patient portal capabilities – or have access to functionalities like Blue Button – should work to educate their patients on the benefits of turning to a portal before making a staff request for record copies. 

“The healthcare industry is at a crossroad of converging technology and regulations influencing patients’ access to their personal health information,” wrote Kim Murphy-Abdouch, MPH, RHIA, FACHE, in the study published in Perspectives in Health Information Management.  Encouraging patient engagement through portals and other electronic methods of health information exchange may help

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“If a patient portal is not available or if patients choose not to use the portal, HIM professionals can assist by establishing a pertinent record set to give patients upon request,” she adds. “This pertinent record set could include summaries of care, laboratory tests, and radiology results and could serve as the starting point for giving patients access to their personal health information.”


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