Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Howard P. Forman

Second Advisor

Harlan M. Krumholz

Abstract

In the United States, patients have a right to access their protected health information under the Health Insurance Portability and Accountability Act. However, this access remains limited. The goal of this study is to evaluate U.S. hospital compliance with federal and state regulations that govern the medical records request process and to assess the ease of patient access to their medical records. First, between August 1 and December 7, 2017, we performed a cross-sectional analysis of the general medical records request processes of 83 top-ranked U.S. hospitals. Second, between June 6 and December 3, 2018, we performed a similar cross-sectional analysis of the radiology imaging request processes of 80 top-ranked U.S. hospitals. For both components of the study, we contacted each hospital’s medical records or radiology department to inquire about their patient request process. A scripted interview was used to create a single-blind, simulated patient experience. Hospitals were compared in terms of requestable information, formats of release, fees, and request processing times. Among the 83 top-ranked U.S. hospitals, there was discordance between information provided on the medical records request forms and that obtained from the simulated patient telephone calls. On the forms, only 44 hospitals (53%) provided patients the option to request their entire medical record, but during the calls, all 83 hospitals stated that they were able to release entire medical records to patients. Similarly, there were discrepancies in the information provided in the calls vs. on the forms for the potential formats of release (69 [83%] vs. 40 [48%] for pick up in person, 20 [24%] vs. 14 [17%] for fax, 39 [47%] vs. 27 [33%] for email, 55 [66%] vs. 35 [42%] for CD, and 21 [25%] vs. 33 [40%] for online patient portals). 48 hospitals (58%) had fees (as much as $541.50 for a 200-page record) above the federal recommendation of $6.50 for electronically maintained records. Additionally, at least six hospitals (7%) were noncompliant with state requirements for processing times. In terms of imaging studies, all 80 hospitals stated that they could provide imaging studies on CDs, but only six (8%) hospitals via email and three (4%) via an online patient portal. Fifty-nine (74%) hospitals stated that they could release copies within 24 hours, 10 (13%) within 2–5 days, eight (10%) within 5–10 days, and three (4%) within 10–30 days from request date. Imaging studies conducted outside of the diagnostic radiology department may need to be requested through the departments that performed the study. Our findings reveal that there are discrepancies in the information provided to patients regarding the general medical records release processes and noncompliance with federal and state regulations and recommendations. In addition, patient access to imaging studies is limited primarily to CD format and complicated due to the dispersion of imaging studies across departments. Policies focused on improving patient access may require stricter regulatory enforcement and consideration of the real barriers to access to ensure that the medical records request process is more transparent and less burdensome for patients. Regulatory reform, administrative guidance, and hospital-level policy changes may be needed to improve patient access.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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