Copy fees limit patient access to medical records, doctors argue

(Reuters Health) - Even though U.S. patients are supposed to have easy access to electronic copies of their medical records, copy fees can prevent people from getting this information when they need it, some doctors argue.

Under federal guidelines issued last year, health providers are permitted to charge fees for labor, costs of creating electronic or paper copies of records and postage, Dr. Harlan Krumholz of Yale School of Medicine in New Haven, Connecticut, and colleagues write in JAMA Internal Medicine.

Even though these guidelines suggest a maximum flat fee of $6.50 for electronic copies of digital records, most state laws and healthcare providers still set per-page copy fees that can add up to much higher costs for patients, the doctors note in their “Viewpoint” article.

“Higher costs are a higher barrier for people to get their own information,” Krumholz told Reuters Health by email.

“Without that information it is not possible to correct errors in the record, get informed second opinions, donate your data to research – or share with others what is happening with your care,” Krumholz added.

The guidelines were issued to help implement the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which was designed in part to usher in a new era of electronic health records to replace older, paper-based systems.

Some healthcare providers, like the Veterans Health Administration, make it easy for patients to go online and download their medical records with just a few mouse clicks, and no fees, Krumholz and colleagues note.

But costs can far exceed that, based on researchers’ estimates of fees in 42 states with laws on the books detailing how much patients should pay for these records.

In Texas, for example, a patient might pay as much as $53.60 for 15 pages of records, not including postage or images, according to researchers’ analysis of 2015 data.

Patients’ copy fees might reach as high as $218.70 for 150 pages of records in Minnesota, or $687.70 for 500 pages, researchers estimated.

Only in Kentucky does state law require health care providers to give patients the first copy of their medical records free of charge.

Kentucky should be a model for other states to follow, the researchers argue.

Krumholz is the founder of Hugo, a software platform designed to help patients easily and freely obtain and share copies of their medical records. He also has grant funding from Johnson and Johnson and Medtronic, and has served as an advisor to UnitedHealth and IBM Watson.

Easy and affordable access to medical records can help patients take charge of their own health and make smarter choices about their care, said Daniel Walker, a researcher at Ohio State University in Columbus who wasn’t involved in the opinion piece.

“Costs to access medical records prevent patient access to their health information,” Walker said by email.

“Preventing this access restricts patient choice about where they seek their medical care, and ultimately undermines patient empowerment and patient centered care - both of which result in better care satisfaction and outcomes,” Walker added.

When fees are too steep, patients should discuss it with their doctor directly, said Dr. Bryan Lee, an ophthalmologist at Stanford University and Altos Eye Physicians in Los Altos, California.

“I would recommend being up front and saying that the cost is a barrier to obtaining a full copy of your records,” Lee, who wasn’t involved in the paper, said by email.

“If the office staff is giving you a hard time, then discuss it directly with your doctor,” Lee added. “It’s hard for me to imagine that a doctor wouldn’t make an accommodation for a patient in that situation.”

SOURCE: JAMA Internal Medicine, online January 30, 2017.