MRO has released the white paper, “Misuse of Patient-Directed Requests for Copies of Medical Records,” authored by two attorneys, Beth Anne Jackson, Esq. and Danielle Wesley, Esq., along with privacy expert Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB. The paper provides insights, education and strategies to help hospitals, health systems and other healthcare provider organizations address issues that arise when attorneys solicit copies of medical records—often through record retrieval companies (RRCs)—under the guise of patient-directed requests.

Essential Guide to Understanding and Mitigating Financial, Legal and Privacy Risk

For Health Information Management (HIM) professionals, in-house attorneys and compliance officers, the tenets set forth in the paper serve as an essential guide to understand and mitigate problems associated with these attorney requests, including the rising financial burden imposed on providers when attorneys shift the costs of medical record production for litigation to providers. The following five areas are covered.

• Perceived loophole in OCR guidance. The paper delves into the history of HIPAA, HITECH and patients’ right to access their Protected Health Information (PHI). This includes examining the language of 2016 OCR guidance that emphasized removal of financial and other roadblocks to individuals’ access to their information by advocating the imposition of a nominal fee for patients to obtain their PHI for personal use, such as providing records to their primary care physician, a mobile healthcare app or to researchers. Though applying a nominal fee for patient-directed disclosures to these types of entities is reasonable, the OCR’s inclusion of the phrase “and it doesn’t matter who the third party is” opened the door for manipulation by attorneys and RRCs demanding the $6.50 fee suggested in the guidance.
• Increasing volumes of attorney requests under the guise of patient-directed requests. Submitted as patient-directed requests, attorney requests for medical records have soared with a specific pattern identified, which is described in the white paper. The volume of these types of requests is growing exponentially. MRO metrics show a steady increase in the number of attorney requests demanding the patient rate. Additionally, an increase in page count and a higher demand for “any or all” records from the designated record set (DRS) are consistently noted with these attorney requests.
• Detrimental impact to healthcare systems and their patients. Neither Congress nor the OCR intended for the individual rights to access under 45 CFR §164.524(c) or the guidance to be interpreted and implemented to (a) shift the costs of obtaining medical records for the purpose of for-profit litigation or other non-healthcare related purposes to providers, (b) subject more PHI than necessary—including sensitive PHI that may or may not be related to the litigation—to disclosure, or (c) remove HIPAA protection resulting from disclosure via RRCs to attorneys. However, healthcare organizations are rightfully concerned about these risks. The paper details the detrimental financial, legal and operational impact to health system enterprises and the risks around patient privacy.
• Recognizing the misuse of patient-directed requests for medical records. Providers should be aware of red flags when receiving incoming requests, including the following:
  • A template form with filled-in blanks and mismatched pronouns is used.
  • The form is included in a larger packet with other documents—such as a HIPAA-compliant authorization.
  • The patient’s signature appears to be copy-pasted or photoshopped. Attorneys or RRCs may lift the patient signature from a driver’s license or other document.
  • The letter is labeled a “HITECH authorization.” This terminology is only used by attorneys and RRCs that work with them.

  The paper provides a thorough list of signs indicating attorney misuse of patient-directed requests.

• Steps for combating the issue. To combat this problem, healthcare organizations need a comprehensive game plan that includes education and awareness across HIM, compliance, legal, risk management and finance. New strategies must also be employed at the national level to raise awareness and garner support. In our paper, we offer a step-by-step approach to assist healthcare organizations in building their game plan.

Conclusion: For the Better Good

In summary, the white paper states, “The issue is not about prohibiting authorized access. The issue is about limiting the ability of attorneys and other third parties to manipulate the OCR guidance and patient-directed requests for their own commercial gain. Healthcare organizations that give in to attorney misuse of patient-directed requests may think that they are mitigating legal risk. Instead, they are welcoming negative financial impacts for themselves and potential adverse privacy effects for their patients. Producing thousands of pages of PHI for the nominal patient fee is not a business practice that can be sustained in the long term by any provider. This cost-shifting cannot be tolerated.

The efforts of attorneys and RRCs to obtain PHI via their mischaracterization of the guidance—which, to date, has not been challenged—is well documented and significantly more advanced than a lone provider’s ability to combat it. While providers are steadfast in protecting patient privacy, they also need to protect their fiscal health. They can only do so by taking concrete steps now to stop disreputable attorney and RRC behavior before the issue becomes a more serious problem and a financial crisis for provider organizations.”
The contents within our white paper are approved and endorsed by the Association of Health Information Outsourcing Services (AHIOS), a membership group composed of Health Information Management outsourcing organizations.

Complete the form on this page to request a copy of the white paper “Misuse of Patient-Directed Requests for Copies of Medical Records.”

In an era of regulatory reform and breach, privacy and security compliance is top of mind for health systems. Healthcare leaders are seeking ways to mitigate risk—including financial penalties, lawsuits, and reputational damage—by improving Protected Health Information (PHI) disclosure management processes. Many are embracing the benefits of taking an enterprise-wide approach and standardizing technology, policies and procedures across points of disclosure within their health systems.

In the December 2018 issue of HCCA’s Compliance Today publication, I authored “Enterprise-wide PHI disclosure management: Closing the compliance gaps,” which covered the following four topics.

Increased Focus on Small Healthcare Breaches

Small breaches affecting fewer than 500 patients at a time have become more frequent than the large cyberattacks we see publicized in the news. A cause of these breaches is improper disclosure of PHI during the Release of Information (ROI) process. With increased frequency and impact on patient privacy, small breaches are getting more attention from the OCR.

Small breaches can be just as costly as large ones in terms of penalties and reputational damage. The risks involved with multiple disclosure points and the lack of standardized processes make PHI disclosure difficult to direct and track, making breaches more likely. An enterprise-wide approach to PHI disclosure management is the recommended solution to the challenges faced by healthcare organizations.

PHI Disclosure Across the Enterprise

Although HIM departments still hold primary responsibility for handling PHI disclosures, other areas— including radiology, business offices, and physician practices— increasingly receive requests to release PHI. The issues around this trend pose risks that can lead to privacy breaches. Here’s why:

• ROI is not a core responsibility of non-HIM staff—and it is not their top priority.
• Other departments lack sufficient knowledge of rules and regulations governing the compliant release of patient information.
• Specialized training and multi-tiered Quality Assurance are required to properly disclose PHI.

Quality Assurance Gaps in Release of Information

Quality and accuracy are important aspects of compliant PHI disclosure. However, since ROI workflows involve a variety of manual steps and are complex, there is room for error. Some startling statistics outlined in the HCCA article include:

• Approximately 30 percent of all submitted ROI authorizations are initially found to be invalid.
• With more than 100 possible combinations of errors or omission points across a wide variety of request types, up to 10 percent are processed with errors if the only line of defense is the person onsite logging the request.
• 5 percent or more of patient data in EMRs have integrity issues, including comingling of patient records.
• Well-trained ROI specialists will catch most of mixed records. However, with just one level of quality control, 1 in every 200 requests will included comingled records.

As a best practice, ROI authorizations and PHI should be checked for accuracy multiple times by specially trained ROI staff and sophisticated technologies to avoid non-compliant requests and/or comingled records. This can be best achieved if PHI disclosure management processes across a healthcare enterprise are streamlined through HIM.

Enterprise-Wide Approach to PHI Disclosure Management

A centralized, enterprise-wide approach to disclosure management is the optimal solution to the imminent challenges that healthcare professionals face. By standardizing processes throughout an organization and applying best practices under HIM’s expertise across the system, healthcare organizations can ensure a steady enforcement of enterprise disclosure policies, a manageable workflow, Quality Assurance and a consistent experience for patients and requesters of PHI. This approach enables healthcare organizations to have complete confidence in achieving compliance. An enterprise-wide strategy not only protects a patient’s privacy, it also protects the institution against breaches, financial risk, lawsuits, and reputational damage.

For more information on breach prevention and tips to protect your organization download MRO’s eBook “Breach Prevention: Tips and Best Practices to Safeguard your Healthcare Organization”