The good news, is patients are entitled to access and retrieve their electronic medical records at little or no cost. The latest federal regulations under the 21st Century CURES Act of 2016, which become effective April 5, 2021, allow patients simpler, less expensive and faster access of their electronic medical records upon request. Patients can now request copies of their medical records through the patient portal provided by the health care provider or one maintained for the patient’s representative allowing downloading of electronic medical records. Alternatively, patients can obtain their records through separate applications available to smartphone users or by electronic delivery through other means, such as a PDF attachment to secure email or by compact disc, or CD (the cost is usually $6.50 per disc). In most cases where electronic medical records are readily available through health information technology systems established by the provider, there is no cost to access them. Moreover, patients may request to have their electronic medical records delivered directly to a third party, such as another health care provider, guardian or attorney. The provider has 30 days to supply the electronic records. If a request for an extension is timely made, then up to 60 days will be allowed. Violations of these regulations subject the provider to stiff monetary fines of up to $100,000 per complaint to be imposed by the ONC (Office of the National Coordinator for Health Information Technology). A brief history is in order.
In 1996, and as modified in 2000, HIPAA (the Health Insurance Portability and Accountability Act) originally allowed patients access to their medical records. The federal regulations were updated and modified again in 2009 and 2013 by the HITECH (Health Information Technology for Economic and Clinical Health) Act, establishing guidelines for the implementation of electronic health information systems and allowing patients different methods to access to their ePHI (electronic Protected Health Information), i.e. medical records, upon request. Health care providers could charge patients their reasonable labor costs, but not for searching, verifying and retrieving medical records. The patient had the right to direct that his/her medical records be sent to a third party (third-party directive), such as another doctor, representative, attorney etc., at no additional cost. The provider had 30 days to comply, unless an extension was requested within this time; then another 30 days were allowed. Failure to comply allowed the patient to file a complaint with the OCR (Office of Civil Rights), which had the authority to direct compliance and impose monetary penalties.
In 2016, Congress passed the CURES Act, which was designed to help accelerate medical product development and bring new innovations and advances to patients who need their medical records in a quicker, more efficient manner and at a lower cost. The CURES Act recognized that patients need to readily obtain their electronic medical records and provided a simple framework to coordinate and readily access their records. By 2017, electronic medical records were maintained and available on health information systems used by 96% of acute care hospitals and 79.7% of office-based physicians. Patients’ electronic medical records, since known as EHI (electronic health information) to replace ePHI, were recognized to belong to the patient and include the physician’s clinical notes to include progress notes, laboratory test results, medications, procedure reports, operative reports and pathology reports. Under the CURES Act, electronic access is defined as an Internet-based method that makes EHI available to patients upon request with no manual effort required by providers, so there is no charge for downloading these records. It also includes email and cloud computing. Fees charged by providers