By Jessica Powers and Richard Klass
Patient access to medical records is growing easier and in greater detail with supporting changes in federal regulations and information technology company offerings. Computers, tablets, mobile phones all work well with provider online portals.
Legislatively, the federal 21st Century Cures Act1 gives patients’ rights to information in eight areas:
- Consultation notes
- Discharge summary notes
- History and physicals
- Imaging narratives
- Lab report narratives
- Pathology report narratives
- Procedure notes
- Progress notes
Updated U.S. Department of Health and Human Services rules (October 6, 2022) expand the definition of electronic health records (EHR). EHR inclusion criteria now extends beyond the United States Core Data for Interoperability (USCDI) Version 1 specification to all electronic Protected Health Information (ePHI). This means beyond the eight core areas patients could have access rights to personal:
- “Medical records and billing records about individuals maintained by or for a covered healthcare provider;
- Enrollment, payment, claims adjudication, and case or medical management record systems; or
- Other records that are used, in whole or in part, by or for the covered entity to make decisions about individuals.2
Where are the holes?
More changes are coming. By year end 2023 federal guidelines are pushing technology advancements that will allow patients to:
- Export electronic health information (EHI) easily and at their convenience.
- Perform a bulk export of EHI to simplify searching EHR systems if necessary.
Hospitals made excellent progress from 2017 to 2021 towards enabling patients who received inpatient care to access health information using applications that meet “application programming interface” (API) specifications. The technology implementation rate rose from 38% in 2017 to 70% in 2020.3 But in 2021 the implementation rate stalled i.e., the adoption rate in hospitals remained at 70%.
While APIs allow different software programs to easily communicate with one another, 30% of hospitals and patients are challenged by interoperability4 issues.
For rural hospitals (1,796) and other financially/technology capability weak providers, the cost of sophisticated EHR systems is a barrier to adopting best-in-class software thereby inhibiting patient data availability. “Small, Critical Access, rural, and independent hospitals (67%) enabled patient access to health information at lower rates compared to their counterparts (72%)5; Patients served by these hospitals experience less access to their data through an application of their choice.6 Overall, half of hospitals without “Top 3” EHR systems do not provide application access to their patients.
The top hospital EHR systems are different than those employed in physician (non-hospital employed) practices. Epic System Corporation (37%), Oracle Cerner (23%), and Meditech (14%) dominate the hospital market.7 Notably for physician practices/ ambulatory care centers, no two EHRs systems are alike. This market is not dominated by a few big players. Software adoption depends upon physician specialty, employed versus independent physician status, and available financial/technology resources. This makes full integration/interoperability of EHR systems across all care sites difficult.
- Smaller/more specialized EHR systems providing patient access portals may only meet the basic requirements outlined by CMS and HHS in the Cures Act and not be inclusive of market need.
Andrew Lee CEO of SurfBigData believes individual hospital policy evolution and data ownership rights hinder EHRs’ full potential more so than technology capabilities. This is a cause of patient reported inconvenience of personal responsibility for providing radiology images to their healthcare providers.
Karl Norris, CEO of Duolark, reports data accuracy in EHRs is a significant issue. “There is a 60% error rate. Mistakes are rarely corrected. Inaccurate data in patients’ records can cause significant adverse and even deadly results.”
Jessica Powers, VP of Strategy and Growth, Inovaare Corporation, can be reached at Jessica.email@example.com. Richard Klass, President, 2CY, Inc., can be reached at firstname.lastname@example.org.
1 HIPAA (1996) codified patients’ right to access their medical records. The 2016 Cures Act supported easier/unrestricted access.
2 HIPPA Definition
3 W. Barker & D. Charles (October 2022), Hospital Capabilities to Enable Patient Electronic Access to Health Information, 2021, Office of National Coordinator for Healthcare Health Information Technology, ONC Data Brief, No. 61.
4 “Interoperability refers to the architecture or standards that make it possible for diverse EHR systems to work compatibly in a true information network,” according to HealthIT.gov.
5 HealthIT.gov, Hospital Capabilities to Enable Patient Electronic Access to Health Information, 2021, ONC Data Brief | No.61 | October 2022
7 Definitive Healthcare, Hospital View, 6/2022. Note: Healthgrades reports slightly different market share numbers: Epic System Corporation (33%), Oracle Cerner (24%), and Meditech (17%) dominate the hospital market. Nicky Scarborough (7/25/2022), EHRs Ranked by Market Share.