US hospitals continue to place cost and processing obstacles in the way of patients requesting their personal medical records, according to a study published online October 5 in JAMA Network Open.

The study highlights the need for tougher enforcement of state and federal policies on the accessibility of protected health information to ensure a smooth, timely, and affordable process for patients, write Carolyn T. Lye, BA, a medical student at Yale School of Medicine, New Haven, Connecticut, and colleagues.

In its survey of 83 top hospitals across 29 states, the study reports that many facilities do not comply with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This federal law guarantees that patients have access to their protected health information within 30 days in their preferred format and at a reasonable charge.

The investigators evaluated adherence to HIPPA guidelines through prescripted telephone interviews conducted with one person at each of the hospitals' medical records departments from August 1 to December 7, 2017.

The elite hospitals were ranked as the top 20 for each of the 16 adult specialties in the 2016-2017 US News & World Report's Best Hospitals National Ranking. The survey found contradictory information about records entitlement, varying release times, and higher-than-recommended fees.

The personal health information

"There were overwhelming inconsistencies in information relayed to patients regarding the personal health information they are allowed to request, as well as the formats and costs of release, both within institutions and across institutions," Lye said in a JAMA news release.

"We also found considerable noncompliance with state and federal regulations and recommendations concerning the costs and processing times associated with providing access to medical records."

In 2017, a report from the US Department Health and Human Services' Office of the National Coordinator for Health Information Technology revealed barriers to patients' obtaining their medical records.

Although all 83 facilities in the study communicated by telephone that they could release a patient's entire medical record, only 53% explicitly stated this on their paper authorization forms, and only 11% stated on forms that they could release physicians' orders.

Discrepancies about available formats emerged in telephone statements vs. statements on forms, pointing to noncompliance with federal regulations that require release in a patient's preferred format.

There was a phone-vs-form discordance of 83% vs. 48% on the option of picking up the records in person and of 24% vs. 17% for transmission by fax. For other release options, the phone-form discrepancies were 47% vs 33% for email, 66% vs 42% for CDs, and 25% vs 40% for online patient portals. There was no discrepancy for release by regular mail (100% both).